- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,197.09 / $6,301.08 / $7,264.77
| Facility | | $5,197.09 | $6,301.08 | $7,264.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,399.83 / $6,399.83 / $6,399.83
| Facility | | $6,399.83 | $6,399.83 | $6,399.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,485.00 / $5,462.00
| Facility | | $1,252.00 | $3,485.00 | $5,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,623.18 / $7,358.83 / $12,630.05
| Facility | | $4,623.18 | $7,358.83 | $12,630.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,044.00 / $10,938.60
| Facility | | $2,332.00 | $5,044.00 | $10,938.60 |