- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.21 / $2,290.21 / $2,290.21
| Facility | | $2,290.21 | $2,290.21 | $2,290.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,387.54 / $9,433.20 / $18,791.54
| Facility | | $4,387.54 | $9,433.20 | $18,791.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,071.27 / $7,191.69 / $17,300.59
| Facility | | $5,071.27 | $7,191.69 | $17,300.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,122.58 / $6,574.93 / $13,622.51
| Facility | | $4,122.58 | $6,574.93 | $13,622.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,969.05 / $3,624.79 / $5,977.29
| Facility | | $2,969.05 | $3,624.79 | $5,977.29 |
- 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 |