- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,075.60 / $10,531.20 / $14,126.70
| Facility | | $5,075.60 | $10,531.20 | $14,126.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,507.55 / $10,507.55 / $13,587.84
| Facility | | $10,507.55 | $10,507.55 | $13,587.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $11,500.00 / $11,500.00
| Facility | | $3,897.00 | $11,500.00 | $11,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,951.54 / $10,874.65 / $17,116.37
| Facility | | $8,951.54 | $10,874.65 | $17,116.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $13,435.34 / $16,967.89
| Facility | | $1,350.00 | $13,435.34 | $16,967.89 |