- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,410.84 / $6,662.52 / $10,156.60
| Facility | | $3,410.84 | $6,662.52 | $10,156.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,364.01 / $8,364.01 / $8,364.01
| Facility | | $8,364.01 | $8,364.01 | $8,364.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,761.87 / $6,050.42 / $9,507.66
| Facility | | $3,761.87 | $6,050.42 | $9,507.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,071.54 / $4,071.54 / $4,071.54
| Facility | | $4,071.54 | $4,071.54 | $4,071.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $6,448.42 / $13,575.72
| Facility | | $3,308.00 | $6,448.42 | $13,575.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,448.42 / $12,064.10
| Facility | | $3,000.00 | $6,448.42 | $12,064.10 |