- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,755.29 / $5,716.88 / $7,668.70
| Facility | | $2,755.29 | $5,716.88 | $7,668.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,796.66 / $5,843.45 / $7,481.89
| Facility | | $3,796.66 | $5,843.45 | $7,481.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $5,140.39 / $6,112.18
| Facility | | $2,651.00 | $5,140.39 | $6,112.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,859.35 / $5,903.30 / $9,291.61
| Facility | | $4,859.35 | $5,903.30 | $9,291.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $7,293.37
| Facility | | $1,350.00 | $5,372.00 | $7,293.37 |