- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,013.50 / $16,804.20 / $23,246.60
| Facility | | $5,013.50 | $16,804.20 | $23,246.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,276.05 / $3,598.89
| Facility | | $1,146.00 | $2,276.05 | $3,598.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,324.86 / $8,739.03 / $16,209.65
| Facility | | $6,324.86 | $8,739.03 | $16,209.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,969.88 / $8,739.03 / $16,209.65
| Facility | | $5,969.88 | $8,739.03 | $16,209.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.68 / $11,185.12 / $17,342.70
| Facility | | $4,712.68 | $11,185.12 | $17,342.70 |