- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,921.08 / $2,921.08 / $2,921.08
| Facility | | $2,921.08 | $2,921.08 | $2,921.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $22,792.89
| Facility | | $4,184.29 | $10,622.61 | $22,792.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,176.09 / $10,176.59 / $24,481.16
| Facility | | $7,176.09 | $10,176.59 | $24,481.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,833.64 / $9,303.84 / $19,276.50
| Facility | | $5,833.64 | $9,303.84 | $19,276.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $4,936.63 / $7,297.25
| Facility | | $3,455.00 | $4,936.63 | $7,297.25 |
- 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 |