- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,443.58 / $2,443.58 / $2,443.58
| Facility | | $2,443.58 | $2,443.58 | $2,443.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,676.05 / $10,053.51 / $20,015.90
| Facility | | $4,676.05 | $10,053.51 | $20,015.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,404.81 / $7,664.69 / $18,438.45
| Facility | | $5,404.81 | $7,664.69 | $18,438.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.72 / $7,007.36 / $14,518.46
| Facility | | $4,393.72 | $7,007.36 | $14,518.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,805.59 / $3,861.23 / $6,098.49
| Facility | | $2,805.59 | $3,861.23 | $6,098.49 |
- 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 |