- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.06 / $2,156.06 / $2,156.06
| Facility | | $2,156.06 | $2,156.06 | $2,156.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $19,972.99
| Facility | | $4,184.29 | $10,622.61 | $19,972.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,314.69 / $7,536.88 / $18,131.00
| Facility | | $5,314.69 | $7,536.88 | $18,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,320.46 / $6,890.52 / $14,276.38
| Facility | | $4,320.46 | $6,890.52 | $14,276.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,656.61 / $3,776.28 / $5,576.00
| Facility | | $2,656.61 | $3,776.28 | $5,576.00 |
- 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 |