- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,802.50 / $16,096.90 / $22,268.20
| Facility | | $4,802.50 | $16,096.90 | $22,268.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,245.60 / $3,558.44
| Facility | | $1,146.00 | $2,245.60 | $3,558.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,058.67 / $8,371.24 / $15,527.44
| Facility | | $6,058.67 | $8,371.24 | $15,527.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,314.84 / $8,371.24 / $15,527.44
| Facility | | $5,314.84 | $8,371.24 | $15,527.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,514.35 / $10,714.38 / $16,612.81
| Facility | | $4,514.35 | $10,714.38 | $16,612.81 |