- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,048.27 / $2,048.27 / $2,048.27
| Facility | | $2,048.27 | $2,048.27 | $2,048.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,530.68 / $10,370.40 / $18,645.16
| Facility | | $4,530.68 | $10,370.40 | $18,645.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,187.50 / $7,356.53 / $17,697.12
| Facility | | $5,187.50 | $7,356.53 | $17,697.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.07 / $6,725.63 / $13,934.74
| Facility | | $4,217.07 | $6,725.63 | $13,934.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,765.99 / $3,647.83 / $5,834.47
| Facility | | $2,765.99 | $3,647.83 | $5,834.47 |
- 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 |