- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,082.99 / $6,162.74 / $7,105.27
| Facility | | $5,082.99 | $6,162.74 | $7,105.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,947.12 / $7,848.77 / $13,779.84
| Facility | | $4,947.12 | $7,848.77 | $13,779.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,067.00 / $4,334.00
| Facility | | $1,252.00 | $3,067.00 | $4,334.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,521.68 / $7,197.27 / $12,352.76
| Facility | | $4,521.68 | $7,197.27 | $12,352.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,044.00 / $10,698.45
| Facility | | $2,332.00 | $5,044.00 | $10,698.45 |