- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,505.44 / $2,505.44 / $2,505.44
| Facility | | $2,505.44 | $2,505.44 | $2,505.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $11,070.22 / $21,619.73
| Facility | | $4,184.29 | $11,070.22 | $21,619.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,182.22 / $8,767.15 / $21,090.57
| Facility | | $6,182.22 | $8,767.15 | $21,090.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,025.70 / $8,015.28 / $16,606.75
| Facility | | $5,025.70 | $8,015.28 | $16,606.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,274.74 / $4,234.18 / $6,508.89
| Facility | | $3,274.74 | $4,234.18 | $6,508.89 |
- 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 |