- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,465.30 / $5,115.20 / $6,861.60
| Facility | | $2,465.30 | $5,115.20 | $6,861.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,350.80 / $13,350.80 / $13,350.80
| Facility | | $13,350.80 | $13,350.80 | $13,350.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,521.73 / $4,298.28 / $5,110.85
| Facility | | $2,521.73 | $4,298.28 | $5,110.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,347.92 / $5,282.00 / $8,313.70
| Facility | | $4,347.92 | $5,282.00 | $8,313.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,148.00 / $6,525.77
| Facility | | $1,350.00 | $5,148.00 | $6,525.77 |