- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,648.20 / $4,648.20 / $4,648.20
| Facility | | $4,648.20 | $4,648.20 | $4,648.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,369.19 / $20,143.75 / $40,538.12
| Facility | | $9,369.19 | $20,143.75 | $40,538.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,775.08 / $15,280.41 / $36,759.08
| Facility | | $10,775.08 | $15,280.41 | $36,759.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,759.37 / $13,969.96 / $28,944.16
| Facility | | $8,759.37 | $13,969.96 | $28,944.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $7,699.87 / $9,698.60
| Facility | | $3,500.00 | $7,699.87 | $9,698.60 |
- 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 |