- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.36 / $2,003.36 / $2,003.36
| Facility | | $2,003.36 | $2,003.36 | $2,003.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,376.14 / $18,862.97
| Facility | | $4,184.29 | $10,376.14 | $18,862.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,948.30 / $7,017.31 / $16,881.08
| Facility | | $4,948.30 | $7,017.31 | $16,881.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,022.61 / $6,415.50 / $13,292.19
| Facility | | $4,022.61 | $6,415.50 | $13,292.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.31 / $3,541.71 / $5,117.43
| Facility | | $2,583.31 | $3,541.71 | $5,117.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |