- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,305.96 / $2,305.96 / $2,305.96
| Facility | | $2,305.96 | $2,305.96 | $2,305.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,399.35 / $9,458.64 / $18,917.41
| Facility | | $4,399.35 | $9,458.64 | $18,917.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,090.64 / $7,219.17 / $17,366.68
| Facility | | $5,090.64 | $7,219.17 | $17,366.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,138.33 / $6,600.05 / $13,674.55
| Facility | | $4,138.33 | $6,600.05 | $13,674.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,857.99 / $3,897.09 / $6,307.30
| Facility | | $2,857.99 | $3,897.09 | $6,307.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |