- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,717.85 / $2,717.85 / $2,717.85
| Facility | | $2,717.85 | $2,717.85 | $2,717.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $22,102.74
| Facility | | $4,184.29 | $10,622.61 | $22,102.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,689.26 / $9,486.20 / $22,820.34
| Facility | | $6,689.26 | $9,486.20 | $22,820.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,437.89 / $8,672.66 / $17,968.78
| Facility | | $5,437.89 | $8,672.66 | $17,968.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,399.19 / $4,593.17 / $6,799.43
| Facility | | $3,399.19 | $4,593.17 | $6,799.43 |
- 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 |