- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.04 / $2,403.04 / $2,403.04
| Facility | | $2,403.04 | $2,403.04 | $2,403.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,605.72 / $9,902.31 / $19,729.84
| Facility | | $4,605.72 | $9,902.31 | $19,729.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,323.11 / $7,548.83 / $18,159.73
| Facility | | $5,323.11 | $7,548.83 | $18,159.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,327.30 / $6,901.44 / $14,299.00
| Facility | | $4,327.30 | $6,901.44 | $14,299.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,850.02 / $3,806.08 / $6,039.20
| Facility | | $2,850.02 | $3,806.08 | $6,039.20 |
- 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 |