- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,546.88 / $4,300.32 / $4,958.02
| Facility | | $3,546.88 | $4,300.32 | $4,958.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,625.64 / $4,625.64 / $5,447.06
| Facility | | $4,625.64 | $4,625.64 | $5,447.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $2,554.00 / $3,843.00
| Facility | | $1,252.00 | $2,554.00 | $3,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,155.20 / $5,022.21 / $8,619.68
| Facility | | $3,155.20 | $5,022.21 | $8,619.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $4,698.53 / $7,465.31
| Facility | | $2,332.00 | $4,698.53 | $7,465.31 |