- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,760.83 / $12,882.50
| Facility | | $3,235.94 | $6,760.83 | $12,882.50 |
- 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 / $2,630.27 / $4,365.16
| Facility | | $1,000.00 | $2,630.27 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- 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 |