- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.33 / $5,675.48 / $7,613.16
| Facility | | $2,735.33 | $5,675.48 | $7,613.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,053.53 / $14,053.53 / $14,053.53
| Facility | | $14,053.53 | $14,053.53 | $14,053.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $850.00 / $850.00
| Facility | | $850.00 | $850.00 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,824.16 / $7,116.56 / $7,988.86
| Facility | | $4,824.16 | $7,116.56 | $7,988.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $7,240.56
| Facility | | $1,350.00 | $5,372.00 | $7,240.56 |