- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.40 / $5,715.04 / $7,666.23
| Facility | | $2,754.40 | $5,715.04 | $7,666.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.43 / $6,107.71 / $13,872.97
| Facility | | $3,036.43 | $6,107.71 | $13,872.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $5,306.21 / $6,309.33
| Facility | | $2,651.00 | $5,306.21 | $6,309.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,857.78 / $5,901.40 / $9,288.62
| Facility | | $4,857.78 | $5,901.40 | $9,288.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $7,291.02
| Facility | | $1,350.00 | $5,372.00 | $7,291.02 |