- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $12,882.50
| Facility | | $4,570.88 | $8,511.38 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,218.10 / $18,620.87
| Facility | | $8,709.64 | $16,218.10 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,466.84 / $7,413.10
| Facility | | $1,000.00 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $10,471.29 / $17,782.79
| Facility | | $1,348.96 | $10,471.29 | $17,782.79 |