- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,522.95 / $8,284.95 / $11,730.60
| Facility | | $4,522.95 | $8,284.95 | $11,730.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,376.85 / $7,096.90 / $11,391.78
| Facility | | $4,376.85 | $7,096.90 | $11,391.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,702.50 / $7,452.75 / $13,259.63
| Facility | | $4,702.50 | $7,452.75 | $13,259.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,491.25 / $7,117.00 / $15,679.53
| Facility | | $3,491.25 | $7,117.00 | $15,679.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $7,117.00 / $13,933.65
| Facility | | $3,000.00 | $7,117.00 | $13,933.65 |