- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,073.80 / $10,715.19
| Facility | | $1,737.80 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,964.78 / $17,378.01
| Facility | | $5,754.40 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,791.08 / $23,442.29
| Facility | | $9,332.54 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $51,286.14 / $51,286.14
| Facility | | $51,286.14 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $15,135.61 / $34,673.69
| Facility | | $9,332.54 | $15,135.61 | $34,673.69 |