- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,461.00 / $11,600.50 / $16,048.00
| Facility | | $3,461.00 | $11,600.50 | $16,048.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $12,781.72
| Facility | | $1,146.00 | $3,000.00 | $12,781.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,366.28 / $6,032.87 / $11,190.11
| Facility | | $4,366.28 | $6,032.87 | $11,190.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,366.28 / $6,229.80 / $11,190.11
| Facility | | $4,366.28 | $6,229.80 | $11,190.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,253.34 / $7,825.32 / $13,438.00
| Facility | | $3,253.34 | $7,825.32 | $13,438.00 |