- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,623.41 / $9,549.93
| Facility | | $1,778.28 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $4,466.84 / $11,481.54
| Facility | | $426.58 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $10,000.00
| Facility | | $2,884.03 | $4,265.80 | $10,000.00 |