- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,544.85 / $9,430.00 / $12,649.50
| Facility | | $4,544.85 | $9,430.00 | $12,649.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,180.15 / $9,180.15 / $9,180.15
| Facility | | $9,180.15 | $9,180.15 | $9,180.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $9,131.93 / $10,858.29
| Facility | | $2,651.00 | $9,131.93 | $10,858.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,015.50 / $9,737.50 / $15,326.53
| Facility | | $8,015.50 | $9,737.50 | $15,326.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $12,030.43
| Facility | | $1,350.00 | $5,713.00 | $12,030.43 |