- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,720.00 / $9,116.85 / $12,612.10
| Facility | | $2,720.00 | $9,116.85 | $12,612.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,193.80 / $3,489.62
| Facility | | $1,146.00 | $2,193.80 | $3,489.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,431.46 / $4,741.22 / $8,794.29
| Facility | | $3,431.46 | $4,741.22 | $8,794.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,431.46 / $4,896.00 / $8,794.29
| Facility | | $3,431.46 | $4,896.00 | $8,794.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $6,068.32 / $9,409.02
| Facility | | $3,036.00 | $6,068.32 | $9,409.02 |