- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,232.93 / $13,182.57
| Facility | | $6,918.31 | $10,232.93 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,265.80 / $9,332.54
| Facility | | $2,344.23 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,897.79 / $9,120.11
| Facility | | $3,548.13 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,897.79 / $9,120.11
| Facility | | $3,548.13 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,309.57 / $10,000.00
| Facility | | $3,019.95 | $6,309.57 | $10,000.00 |