- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,424.68 / $9,180.68 / $12,315.10
| Facility | | $4,424.68 | $9,180.68 | $12,315.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,388.15 / $5,388.15 / $9,146.49
| Facility | | $5,388.15 | $5,388.15 | $9,146.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $8,192.48 / $9,741.24
| Facility | | $2,651.00 | $8,192.48 | $9,741.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,803.58 / $9,480.04 / $14,921.31
| Facility | | $7,803.58 | $9,480.04 | $14,921.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,888.00 / $13,467.66
| Facility | | $1,500.00 | $5,888.00 | $13,467.66 |