- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,165.95 / $10,964.78
| Facility | | $2,344.23 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $10,964.78
| Facility | | $5,623.41 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,413.10 / $15,135.61
| Facility | | $4,677.35 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,495.41 / $11,481.54
| Facility | | $3,981.07 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,370.32 / $10,000.00
| Facility | | $3,467.37 | $5,370.32 | $10,000.00 |