- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.00 / $11,469.80 / $15,867.10
| Facility | | $3,422.00 | $11,469.80 | $15,867.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,543.95
| Facility | | $1,146.00 | $3,000.00 | $7,543.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,317.08 / $5,964.89 / $11,064.01
| Facility | | $4,317.08 | $5,964.89 | $11,064.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,317.08 / $6,159.60 / $11,064.01
| Facility | | $4,317.08 | $6,159.60 | $11,064.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,216.68 / $7,634.48 / $11,837.38
| Facility | | $3,216.68 | $7,634.48 | $11,837.38 |