- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.67 / $2,496.67 / $2,496.67
| Facility | | $2,496.67 | $2,496.67 | $2,496.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,774.63 / $10,265.45 / $20,613.77
| Facility | | $4,774.63 | $10,265.45 | $20,613.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,513.46 / $7,818.77 / $18,809.11
| Facility | | $5,513.46 | $7,818.77 | $18,809.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,482.05 / $7,148.23 / $14,810.33
| Facility | | $4,482.05 | $7,148.23 | $14,810.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,827.28 / $3,945.29 / $6,231.89
| Facility | | $2,827.28 | $3,945.29 | $6,231.89 |
- 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 |