- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.57 / $2,155.57 / $2,155.57
| Facility | | $2,155.57 | $2,155.57 | $2,155.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $19,952.96
| Facility | | $4,184.29 | $10,622.61 | $19,952.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,321.42 / $7,546.44 / $18,153.98
| Facility | | $5,321.42 | $7,546.44 | $18,153.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,325.93 / $6,899.26 / $14,294.48
| Facility | | $4,325.93 | $6,899.26 | $14,294.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,543.53 / $3,803.01 / $5,473.17
| Facility | | $2,543.53 | $3,803.01 | $5,473.17 |
- 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 |