- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,387.66 / $4,387.66 / $4,387.66
| Facility | | $4,387.66 | $4,387.66 | $4,387.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,849.99 / $19,027.48 / $38,195.26
| Facility | | $8,849.99 | $19,027.48 | $38,195.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,182.12 / $14,439.52 / $34,736.23
| Facility | | $10,182.12 | $14,439.52 | $34,736.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,277.34 / $13,201.19 / $27,351.36
| Facility | | $8,277.34 | $13,201.19 | $27,351.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $7,291.61 / $9,103.00
| Facility | | $3,500.00 | $7,291.61 | $9,103.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |