- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.10 / $5,004.80 / $6,713.50
| Facility | | $2,412.10 | $5,004.80 | $6,713.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,489.24 / $5,611.00 / $10,432.29
| Facility | | $3,489.24 | $5,611.00 | $10,432.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,641.67 / $4,502.70 / $5,353.93
| Facility | | $2,641.67 | $4,502.70 | $5,353.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,254.08 / $5,168.00 / $8,134.27
| Facility | | $4,254.08 | $5,168.00 | $8,134.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,148.00 / $6,384.93
| Facility | | $1,350.00 | $5,148.00 | $6,384.93 |