- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,165.95 / $10,471.29
| Facility | | $2,238.72 | $6,165.95 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $12,022.64
| Facility | | $3,630.78 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $3,548.13
| Facility | | $1,000.00 | $1,000.00 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $7,762.47 / $11,481.54
| Facility | | $1,047.13 | $7,762.47 | $11,481.54 |