- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,194.20 / $5,862.50 / $9,516.68
| Facility | | $4,194.20 | $5,862.50 | $9,516.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,618.11 / $13,618.11 / $13,618.11
| Facility | | $13,618.11 | $13,618.11 | $13,618.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,416.46 / $6,278.66 / $8,049.57
| Facility | | $4,416.46 | $6,278.66 | $8,049.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,720.42 / $9,126.50 / $11,543.37
| Facility | | $4,720.42 | $9,126.50 | $11,543.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,194.20 / $6,304.70 / $10,081.50
| Facility | | $4,194.20 | $6,304.70 | $10,081.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,905.07 / $8,387.73 / $12,743.40
| Facility | | $4,905.07 | $8,387.73 | $12,743.40 |