- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.44 / $2,327.44 / $2,327.44
| Facility | | $2,327.44 | $2,327.44 | $2,327.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $10,743.99 / $21,404.08
| Facility | | $4,142.55 | $10,743.99 | $21,404.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,788.88 / $8,209.35 / $19,748.71
| Facility | | $5,788.88 | $8,209.35 | $19,748.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.93 / $7,505.32 / $15,550.16
| Facility | | $4,705.93 | $7,505.32 | $15,550.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,097.65 / $3,954.00 / $6,176.31
| Facility | | $3,097.65 | $3,954.00 | $6,176.31 |
- 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 |