- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,225.29 / $6,692.08 / $8,976.84
| Facility | | $3,225.29 | $6,692.08 | $8,976.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,931.61 / $5,931.61 / $8,210.78
| Facility | | $5,931.61 | $5,931.61 | $8,210.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $5,542.32 / $6,590.08
| Facility | | $2,651.00 | $5,542.32 | $6,590.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,688.27 / $6,910.30 / $10,876.60
| Facility | | $5,688.27 | $6,910.30 | $10,876.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,468.00 / $9,816.99
| Facility | | $1,500.00 | $5,468.00 | $9,816.99 |