- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,585.78 / $20,417.38
| Facility | | $4,897.79 | $7,585.78 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,309.57 / $10,000.00
| Facility | | $4,365.16 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,232.93 / $13,803.84
| Facility | | $6,456.54 | $10,232.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $29,512.09 / $29,512.09
| Facility | | $29,512.09 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,471.29 / $16,218.10
| Facility | | $2,951.21 | $10,471.29 | $16,218.10 |