- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,687.12 / $2,687.12 / $2,687.12
| Facility | | $2,687.12 | $2,687.12 | $2,687.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $21,640.07
| Facility | | $4,184.29 | $10,622.61 | $21,640.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,557.87 / $9,299.87 / $22,372.10
| Facility | | $6,557.87 | $9,299.87 | $22,372.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,331.07 / $8,502.31 / $17,615.83
| Facility | | $5,331.07 | $8,502.31 | $17,615.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,290.97 / $4,541.22 / $6,609.86
| Facility | | $3,290.97 | $4,541.22 | $6,609.86 |
- 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 |