- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,208.57 / $2,208.57 / $2,208.57
| Facility | | $2,208.57 | $2,208.57 | $2,208.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,629.47 / $20,728.20
| Facility | | $4,184.29 | $10,629.47 | $20,728.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,435.97 / $7,708.88 / $18,544.75
| Facility | | $5,435.97 | $7,708.88 | $18,544.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,419.05 / $7,047.77 / $14,602.18
| Facility | | $4,419.05 | $7,047.77 | $14,602.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.71 / $3,888.85 / $5,600.09
| Facility | | $2,264.71 | $3,888.85 | $5,600.09 |
- 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 |