- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $10,471.29 / $33,113.11
| Facility | | $5,495.41 | $10,471.29 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,120.11 / $21,877.62
| Facility | | $6,456.54 | $9,120.11 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,709.64 / $17,378.01
| Facility | | $7,079.46 | $8,709.64 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,467.37 / $7,079.46
| Facility | | $2,089.30 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,311.31 / $8,511.38
| Facility | | $1,584.89 | $3,311.31 | $8,511.38 |