- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,912.51 / $11,748.98
| Facility | | $3,467.37 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,709.64 / $9,772.37
| Facility | | $6,309.57 | $8,709.64 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,332.54 / $12,882.50
| Facility | | $7,585.78 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,165.95 / $12,882.50
| Facility | | $1,819.70 | $6,165.95 | $12,882.50 |