- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,233.01 / $10,857.80 / $14,564.80
| Facility | | $5,233.01 | $10,857.80 | $14,564.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,598.01 / $5,598.01 / $5,598.01
| Facility | | $5,598.01 | $5,598.01 | $5,598.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $14,234.29 / $16,925.23
| Facility | | $3,897.00 | $14,234.29 | $16,925.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,229.16 / $11,211.90 / $17,647.18
| Facility | | $9,229.16 | $11,211.90 | $17,647.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $13,852.01 / $17,494.09
| Facility | | $1,350.00 | $13,852.01 | $17,494.09 |