- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,678.50 / $12,329.50 / $17,056.50
| Facility | | $3,678.50 | $12,329.50 | $17,056.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,672.33
| Facility | | $1,146.00 | $3,000.00 | $5,672.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,640.67 / $6,411.99 / $11,893.33
| Facility | | $4,640.67 | $6,411.99 | $11,893.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,640.67 / $6,621.30 / $11,893.33
| Facility | | $4,640.67 | $6,621.30 | $11,893.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,457.79 / $8,206.73 / $12,724.67
| Facility | | $3,457.79 | $8,206.73 | $12,724.67 |