- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,136.02 / $6,774.95 / $15,296.65
| Facility | | $3,136.02 | $6,774.95 | $15,296.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,038.43 / $10,426.29 / $18,708.55
| Facility | | $4,038.43 | $10,426.29 | $18,708.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.73 / $2,000.00 / $5,740.31
| Facility | | $1,171.73 | $2,000.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.59 / $1,420.42 / $2,278.57
| Facility | | $1,080.59 | $1,420.42 | $2,278.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |