- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,248.07 / $6,309.57
| Facility | | $3,981.07 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $2,041.74 / $5,011.87
| Facility | | $85.11 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,762.47 / $7,762.47
| Facility | | $2,818.38 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,265.80 / $6,309.57
| Facility | | $3,981.07 | $4,265.80 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |