- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,846.63 / $5,906.40 / $7,922.92
| Facility | | $2,846.63 | $5,906.40 | $7,922.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,338.16 / $6,338.16 / $6,338.16
| Facility | | $6,338.16 | $6,338.16 | $6,338.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,113.34 / $8,458.09
| Facility | | $2,651.00 | $7,113.34 | $8,458.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,020.43 / $6,099.00 / $9,599.64
| Facility | | $5,020.43 | $6,099.00 | $9,599.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,468.00 / $7,535.15
| Facility | | $1,350.00 | $5,468.00 | $7,535.15 |