- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.63 / $2,219.63 / $2,219.63
| Facility | | $2,219.63 | $2,219.63 | $2,219.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,251.49 / $9,140.70 / $18,199.39
| Facility | | $4,251.49 | $9,140.70 | $18,199.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,916.30 / $6,971.92 / $16,771.89
| Facility | | $4,916.30 | $6,971.92 | $16,771.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,996.59 / $6,374.00 / $13,206.21
| Facility | | $3,996.59 | $6,374.00 | $13,206.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,780.87 / $3,516.48 / $5,630.66
| Facility | | $2,780.87 | $3,516.48 | $5,630.66 |
- 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 |