- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,241.91 / $2,241.91 / $2,241.91
| Facility | | $2,241.91 | $2,241.91 | $2,241.91 |
- 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
- $5,204.81 / $8,123.35 / $19,541.82
| Facility | | $5,204.81 | $8,123.35 | $19,541.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,510.42 / $7,413.09 / $15,387.26
| Facility | | $4,510.42 | $7,413.09 | $15,387.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.63 / $3,628.56 / $6,829.31
| Facility | | $2,155.63 | $3,628.56 | $6,829.31 |
- 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 |