- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.52 / $2,621.52 / $2,621.52
| Facility | | $2,621.52 | $2,621.52 | $2,621.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $20,442.54
| Facility | | $4,184.29 | $10,622.61 | $20,442.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,492.17 / $9,206.70 / $22,147.97
| Facility | | $6,492.17 | $9,206.70 | $22,147.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,277.67 / $8,417.14 / $17,439.34
| Facility | | $5,277.67 | $8,417.14 | $17,439.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,205.77 / $4,430.37 / $6,369.00
| Facility | | $3,205.77 | $4,430.37 | $6,369.00 |
- 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 |