- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,456.54 / $17,378.01
| Facility | | $4,073.80 | $6,456.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,011.87 / $7,762.47
| Facility | | $3,467.37 | $5,011.87 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,709.64 / $11,481.54
| Facility | | $5,495.41 | $8,709.64 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $25,118.86
| Facility | | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,912.51 / $13,489.63
| Facility | | $2,951.21 | $8,912.51 | $13,489.63 |