- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,792.80 / $6,989.50 / $11,346.20
| Facility | | $4,792.80 | $6,989.50 | $11,346.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,717.94 / $9,717.94 / $11,777.55
| Facility | | $9,717.94 | $9,717.94 | $11,777.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,838.40 / $16,830.05 / $21,576.99
| Facility | | $11,838.40 | $16,830.05 | $21,576.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,627.87 / $10,880.97 / $13,762.45
| Facility | | $5,627.87 | $10,880.97 | $13,762.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.49 / $7,516.71 / $12,019.50
| Facility | | $5,000.49 | $7,516.71 | $12,019.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,848.01 / $10,000.18 / $15,193.18
| Facility | | $5,848.01 | $10,000.18 | $15,193.18 |