- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,999.20 / $12,447.60 / $16,697.40
| Facility | | $5,999.20 | $12,447.60 | $16,697.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,049.83 / $25,049.83 / $25,049.83
| Facility | | $25,049.83 | $25,049.83 | $25,049.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $9,591.44 / $11,404.66
| Facility | | $3,897.00 | $9,591.44 | $11,404.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,580.46 / $12,853.50 / $20,231.02
| Facility | | $10,580.46 | $12,853.50 | $20,231.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $15,880.16 / $20,055.52
| Facility | | $1,350.00 | $15,880.16 | $20,055.52 |