- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,332.54 / $12,589.25
| Facility | | $3,715.35 | $9,332.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,549.93 / $10,715.19
| Facility | | $6,918.31 | $9,549.93 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,000.00 / $13,803.84
| Facility | | $7,943.28 | $10,000.00 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,165.95 / $12,302.69
| Facility | | $1,819.70 | $6,165.95 | $12,302.69 |