- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,244.36 / $19,498.45
| Facility | | $4,570.88 | $7,244.36 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,025.60 / $9,549.93
| Facility | | $4,168.69 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,549.93 / $12,882.50
| Facility | | $6,165.95 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,000.00 / $15,135.61
| Facility | | $2,951.21 | $10,000.00 | $15,135.61 |