- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.09 / $5,208.12 / $6,986.24
| Facility | | $2,510.09 | $5,208.12 | $6,986.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,148.53 / $5,231.32 / $5,658.55
| Facility | | $4,148.53 | $5,231.32 | $5,658.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $4,913.93 / $5,842.91
| Facility | | $2,651.00 | $4,913.93 | $5,842.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,426.89 / $5,377.95 / $8,464.73
| Facility | | $4,426.89 | $5,377.95 | $8,464.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,148.00 / $6,644.32
| Facility | | $1,350.00 | $5,148.00 | $6,644.32 |