- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,520.91 / $9,380.32 / $12,582.90
| Facility | | $4,520.91 | $9,380.32 | $12,582.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,052.50 / $12,052.50 / $12,052.50
| Facility | | $12,052.50 | $12,052.50 | $12,052.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,632.43 / $11,453.41
| Facility | | $2,651.00 | $9,632.43 | $11,453.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,973.27 / $9,686.20 / $15,245.78
| Facility | | $7,973.27 | $9,686.20 | $15,245.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $11,967.05
| Facility | | $1,350.00 | $5,713.00 | $11,967.05 |