- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,813.06 / $5,835.47 / $6,727.96
| Facility | | $4,813.06 | $5,835.47 | $6,727.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,475.12 / $7,475.12 / $12,910.78
| Facility | | $7,475.12 | $7,475.12 | $12,910.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,067.00 / $4,334.00
| Facility | | $1,252.00 | $3,067.00 | $4,334.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,281.56 / $6,815.06 / $11,696.78
| Facility | | $4,281.56 | $6,815.06 | $11,696.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,044.00 / $10,130.32
| Facility | | $2,332.00 | $5,044.00 | $10,130.32 |