- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,461.98 / $2,461.98 / $2,461.98
| Facility | | $2,461.98 | $2,461.98 | $2,461.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,709.57 / $10,125.58 / $20,253.34
| Facility | | $4,709.57 | $10,125.58 | $20,253.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,453.66 / $7,733.97 / $18,605.09
| Facility | | $5,453.66 | $7,733.97 | $18,605.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,433.43 / $7,070.70 / $14,649.69
| Facility | | $4,433.43 | $7,070.70 | $14,649.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,262.59 / $3,895.76 / $6,509.12
| Facility | | $3,262.59 | $3,895.76 | $6,509.12 |
- 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 |