- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,124.60 / $5,691.31 / $9,525.23
| Facility | | $4,124.60 | $5,691.31 | $9,525.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,674.20 / $9,927.65 / $15,489.03
| Facility | | $6,674.20 | $9,927.65 | $15,489.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.00 / $3,447.00 / $6,417.03
| Facility | | $1,790.00 | $3,447.00 | $6,417.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,221.51 / $6,402.97 / $10,737.73
| Facility | | $4,221.51 | $6,402.97 | $10,737.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $5,167.55 / $11,490.64
| Facility | | $2,600.00 | $5,167.55 | $11,490.64 |