- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.27 / $2,561.27 / $2,561.27
| Facility | | $2,561.27 | $2,561.27 | $2,561.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,908.04 / $10,552.29 / $21,068.62
| Facility | | $4,908.04 | $10,552.29 | $21,068.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,664.23 / $8,032.58 / $19,323.45
| Facility | | $5,664.23 | $8,032.58 | $19,323.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,604.60 / $7,343.70 / $15,215.31
| Facility | | $4,604.60 | $7,343.70 | $15,215.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,786.82 / $4,059.88 / $6,355.80
| Facility | | $2,786.82 | $4,059.88 | $6,355.80 |
- 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 |