- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,795.19 / $5,799.68 / $7,779.77
| Facility | | $2,795.19 | $5,799.68 | $7,779.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.73 / $6,235.34 / $6,301.01
| Facility | | $3,390.73 | $6,235.34 | $6,301.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $6,132.43 / $7,291.75
| Facility | | $2,651.00 | $6,132.43 | $7,291.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,929.72 / $5,988.80 / $9,426.19
| Facility | | $4,929.72 | $5,988.80 | $9,426.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $7,399.00
| Facility | | $1,350.00 | $5,372.00 | $7,399.00 |