- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,704.83 / $5,704.25 / $6,576.66
| Facility | | $4,704.83 | $5,704.25 | $6,576.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,355.27 / $6,563.03 / $9,658.01
| Facility | | $6,355.27 | $6,563.03 | $9,658.01 |
- 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
- $4,185.28 / $6,661.81 / $11,433.75
| Facility | | $4,185.28 | $6,661.81 | $11,433.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.00 / $4,993.00 / $9,902.52
| Facility | | $1,046.00 | $4,993.00 | $9,902.52 |