- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,170.75 / $6,578.92 / $8,825.04
| Facility | | $3,170.75 | $6,578.92 | $8,825.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,550.84 / $3,550.84 / $3,550.84
| Facility | | $3,550.84 | $3,550.84 | $3,550.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $7,190.23 / $8,549.51
| Facility | | $2,651.00 | $7,190.23 | $8,549.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,592.08 / $6,793.45 / $10,692.68
| Facility | | $5,592.08 | $6,793.45 | $10,692.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,372.00 / $8,393.12
| Facility | | $1,350.00 | $5,372.00 | $8,393.12 |