- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,101.30 / $6,930.54 / $10,912.60
| Facility | | $5,101.30 | $6,930.54 | $10,912.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,152.20 / $6,529.27 / $10,695.77
| Facility | | $4,152.20 | $6,529.27 | $10,695.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,450.22 / $6,143.80 / $11,120.00
| Facility | | $4,450.22 | $6,143.80 | $11,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.30 / $68.72 / $118.08
| Facility | | $47.30 | $68.72 | $118.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,901.70 / $6,783.76 / $11,164.48
| Facility | | $4,901.70 | $6,783.76 | $11,164.48 |