- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,760.83 / $10,715.19
| Facility | | $3,890.45 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,748.98 / $13,803.84
| Facility | | $6,760.83 | $11,748.98 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,011.87 / $8,128.31
| Facility | | $1,000.00 | $5,011.87 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- 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 |