- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.50 / $16,361.70 / $22,634.50
| Facility | | $4,881.50 | $16,361.70 | $22,634.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,358.67
| Facility | | $1,146.00 | $3,000.00 | $6,358.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,158.33 / $8,508.94 / $15,782.87
| Facility | | $6,158.33 | $8,508.94 | $15,782.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,158.33 / $8,786.70 / $15,782.87
| Facility | | $6,158.33 | $8,786.70 | $15,782.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,588.60 / $10,890.63 / $16,886.08
| Facility | | $4,588.60 | $10,890.63 | $16,886.08 |