- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.50 / $11,582.10 / $16,022.50
| Facility | | $3,455.50 | $11,582.10 | $16,022.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,489.55 / $3,882.55
| Facility | | $1,146.00 | $2,489.55 | $3,882.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,359.34 / $6,023.28 / $11,172.32
| Facility | | $4,359.34 | $6,023.28 | $11,172.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,359.34 / $6,023.28 / $11,172.32
| Facility | | $4,359.34 | $6,023.28 | $11,172.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.17 / $7,709.22 / $11,953.27
| Facility | | $3,248.17 | $7,709.22 | $11,953.27 |