- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.00 / $5,608.00 / $5,773.00
| Facility | | $5,242.00 | $5,608.00 | $5,773.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,840.00 / $2,300.79 / $2,559.44
| Facility | | $1,840.00 | $2,300.79 | $2,559.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.08 / $1,329.01 / $1,903.19
| Facility | | $1,100.08 | $1,329.01 | $1,903.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,436.00 / $4,694.00
| Facility | | $1,924.00 | $2,436.00 | $4,694.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,871.43 / $4,871.43 / $4,871.43
| Facility | | $4,871.43 | $4,871.43 | $4,871.43 |