- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.91 / $2,960.91 / $2,960.91
| Facility | | $2,960.91 | $2,960.91 | $2,960.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $22,896.28
| Facility | | $4,184.29 | $10,622.61 | $22,896.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,983.21 / $9,903.06 / $23,823.15
| Facility | | $6,983.21 | $9,903.06 | $23,823.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,676.85 / $9,053.77 / $18,758.39
| Facility | | $5,676.85 | $9,053.77 | $18,758.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,261.38 / $5,003.93 / $6,680.27
| Facility | | $3,261.38 | $5,003.93 | $6,680.27 |
- 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 |