- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,128.61 / $5,888.44
| Facility | | $3,981.07 | $5,128.61 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $7,762.47
| Facility | | $2,089.30 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,897.79 / $5,888.44
| Facility | | $4,168.69 | $4,897.79 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,888.44 / $7,244.36
| Facility | | $3,630.78 | $5,888.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $9,332.54
| Facility | | $2,398.83 | $2,398.83 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,370.32 / $6,918.31
| Facility | | $1,513.56 | $5,370.32 | $6,918.31 |