- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,191.88 / $6,294.75 / $7,257.48
| Facility | | $5,191.88 | $6,294.75 | $7,257.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,867.89 / $7,867.89 / $7,939.29
| Facility | | $7,867.89 | $7,867.89 | $7,939.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $2,554.00 / $3,843.00
| Facility | | $1,252.00 | $2,554.00 | $3,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,618.54 / $7,351.44 / $12,617.37
| Facility | | $4,618.54 | $7,351.44 | $12,617.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,044.00 / $10,927.62
| Facility | | $2,332.00 | $5,044.00 | $10,927.62 |