- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,142.41 / $2,142.41 / $2,142.41
| Facility | | $2,142.41 | $2,142.41 | $2,142.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,156.85 / $8,937.25 / $18,127.87
| Facility | | $4,156.85 | $8,937.25 | $18,127.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,734.37 / $6,713.92 / $16,151.24
| Facility | | $4,734.37 | $6,713.92 | $16,151.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,848.70 / $6,138.13 / $12,717.51
| Facility | | $3,848.70 | $6,138.13 | $12,717.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,981.17 / $3,500.00 / $5,683.46
| Facility | | $2,981.17 | $3,500.00 | $5,683.46 |
- 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 |