- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,152.00 / $10,564.80 / $14,615.20
| Facility | | $3,152.00 | $10,564.80 | $14,615.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,671.55 / $4,124.34
| Facility | | $1,146.00 | $2,671.55 | $4,124.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,976.46 / $5,494.25 / $10,191.04
| Facility | | $3,976.46 | $5,494.25 | $10,191.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,976.46 / $5,673.60 / $10,191.04
| Facility | | $3,976.46 | $5,673.60 | $10,191.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $7,032.11 / $10,903.40
| Facility | | $3,036.00 | $7,032.11 | $10,903.40 |