- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,888.97 / $5,291.90 / $7,492.77
| Facility | | $2,888.97 | $5,291.90 | $7,492.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,421.67 / $5,503.78 / $8,794.99
| Facility | | $3,421.67 | $5,503.78 | $8,794.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,003.66 / $6,080.14 / $11,021.61
| Facility | | $3,003.66 | $6,080.14 | $11,021.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $4,674.76 / $10,015.09
| Facility | | $3,000.00 | $4,674.76 | $10,015.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.42 / $4,962.22 / $8,899.94
| Facility | | $1,911.42 | $4,962.22 | $8,899.94 |