- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,888.44 / $8,912.51
| Facility | | $4,265.80 | $5,888.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,370.32 / $8,317.64
| Facility | | $3,311.31 | $5,370.32 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,128.61 / $9,120.11
| Facility | | $3,630.78 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $60.26 / $100.00
| Facility | | $40.74 | $60.26 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,754.40 / $8,511.38
| Facility | | $3,981.07 | $5,754.40 | $8,511.38 |