- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,565.80 / $4,920.24 / $8,234.73
| Facility | | $3,565.80 | $4,920.24 | $8,234.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,387.05 / $5,387.05 / $5,387.05
| Facility | | $5,387.05 | $5,387.05 | $5,387.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $5,514.16 / $8,385.98
| Facility | | $2,423.00 | $5,514.16 | $8,385.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,649.57 / $5,535.48 / $9,300.00
| Facility | | $3,649.57 | $5,535.48 | $9,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.15 / $4,754.39 / $9,966.12
| Facility | | $2,561.15 | $4,754.39 | $9,966.12 |