- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,786.30 / $6,456.54
| Facility | | $1,905.46 | $4,786.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $7,762.47
| Facility | | $4,897.79 | $4,897.79 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,786.30 / $5,495.41
| Facility | | $3,548.13 | $4,786.30 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,128.61 / $7,079.46
| Facility | | $4,073.80 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,248.07 / $6,760.83
| Facility | | $1,819.70 | $5,248.07 | $6,760.83 |