- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,244.36 / $19,952.62
| Facility | | $4,677.35 | $7,244.36 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,332.54 / $14,791.08
| Facility | | $6,456.54 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,772.37 / $13,182.57
| Facility | | $6,309.57 | $9,772.37 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $28,840.32
| Facility | | $28,840.32 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,232.93 / $15,488.17
| Facility | | $2,951.21 | $10,232.93 | $15,488.17 |