- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.01 / $2,285.01 / $2,285.01
| Facility | | $2,285.01 | $2,285.01 | $2,285.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,231.84 / $18,919.45
| Facility | | $4,184.29 | $10,231.84 | $18,919.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,630.53 / $7,984.80 / $19,208.50
| Facility | | $5,630.53 | $7,984.80 | $19,208.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,577.22 / $7,300.02 / $15,124.81
| Facility | | $4,577.22 | $7,300.02 | $15,124.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.11 / $3,952.96 / $5,521.34
| Facility | | $2,851.11 | $3,952.96 | $5,521.34 |
- 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 |