- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,655.00 / $2,655.00 / $2,655.00
| Facility | | $2,655.00 | $2,655.00 | $2,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $11,070.22 / $23,118.11
| Facility | | $4,184.29 | $11,070.22 | $23,118.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,530.07 / $9,260.45 / $22,277.28
| Facility | | $6,530.07 | $9,260.45 | $22,277.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,308.48 / $8,466.28 / $17,541.16
| Facility | | $5,308.48 | $8,466.28 | $17,541.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $4,486.95 / $7,015.63
| Facility | | $3,455.00 | $4,486.95 | $7,015.63 |
- 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 |