- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,410.50 / $11,431.30 / $15,813.80
| Facility | | $3,410.50 | $11,431.30 | $15,813.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $8,072.66
| Facility | | $1,146.00 | $3,000.00 | $8,072.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,302.57 / $5,944.84 / $11,026.83
| Facility | | $4,302.57 | $5,944.84 | $11,026.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,302.57 / $5,944.84 / $11,026.83
| Facility | | $4,302.57 | $5,944.84 | $11,026.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,205.87 / $7,608.83 / $11,797.60
| Facility | | $3,205.87 | $7,608.83 | $11,797.60 |