- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,128.21 / $2,128.21 / $2,128.21
| Facility | | $2,128.21 | $2,128.21 | $2,128.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $6,665.78 / $16,064.62
| Facility | | $2,509.28 | $6,665.78 | $16,064.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.09 / $7,412.66 / $17,832.16
| Facility | | $5,227.09 | $7,412.66 | $17,832.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,249.25 / $6,776.95 / $14,041.08
| Facility | | $4,249.25 | $6,776.95 | $14,041.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,768.63 / $3,643.24 / $5,178.58
| Facility | | $2,768.63 | $3,643.24 | $5,178.58 |
- 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 |