- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,657.50 / $22,314.50 / $30,869.50
| Facility | | $6,657.50 | $22,314.50 | $30,869.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,294.25
| Facility | | $1,146.00 | $3,000.00 | $7,294.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,398.87 / $11,604.69 / $21,525.03
| Facility | | $8,398.87 | $11,604.69 | $21,525.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,398.87 / $11,983.50 / $21,525.03
| Facility | | $8,398.87 | $11,983.50 | $21,525.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $14,852.88 / $23,029.62
| Facility | | $5,419.00 | $14,852.88 | $23,029.62 |