- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.50 / $9,487.21 / $13,124.50
| Facility | | $2,830.50 | $9,487.21 | $13,124.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,664.90 / $4,115.51
| Facility | | $1,146.00 | $2,664.90 | $4,115.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,570.86 / $4,933.84 / $9,151.57
| Facility | | $3,570.86 | $4,933.84 | $9,151.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,570.86 / $5,094.89 / $9,151.57
| Facility | | $3,570.86 | $5,094.89 | $9,151.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $6,314.85 / $9,791.27
| Facility | | $3,036.00 | $6,314.85 | $9,791.27 |