- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.13 / $2,257.13 / $2,257.13
| Facility | | $2,257.13 | $2,257.13 | $2,257.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $10,376.14 / $20,193.11
| Facility | | $4,166.47 | $10,376.14 | $20,193.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,256.85 / $8,204.57 / $19,737.21
| Facility | | $5,256.85 | $8,204.57 | $19,737.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,555.52 / $7,487.21 / $15,541.11
| Facility | | $4,555.52 | $7,487.21 | $15,541.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,214.15 / $3,780.43 / $6,900.45
| Facility | | $2,214.15 | $3,780.43 | $6,900.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |