- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,524.20 / $8,058.09 / $12,974.60
| Facility | | $3,524.20 | $8,058.09 | $12,974.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,600.40 / $8,600.40 / $8,600.40
| Facility | | $8,600.40 | $8,600.40 | $8,600.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $5,879.35 / $11,791.67
| Facility | | $1,474.01 | $5,879.35 | $11,791.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,833.02 / $8,425.25 / $11,935.38
| Facility | | $5,833.02 | $8,425.25 | $11,935.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,098.70 / $7,066.49 / $14,840.50
| Facility | | $5,098.70 | $7,066.49 | $14,840.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,787.14 / $7,066.49 / $15,032.12
| Facility | | $4,787.14 | $7,066.49 | $15,032.12 |