- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.50 / $11,940.70 / $16,518.59
| Facility | | $3,562.50 | $11,940.70 | $16,518.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,736.30 / $4,210.37
| Facility | | $1,146.00 | $2,736.30 | $4,210.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,494.33 / $6,209.79 / $11,518.28
| Facility | | $4,494.33 | $6,209.79 | $11,518.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,494.33 / $6,209.79 / $11,518.28
| Facility | | $4,494.33 | $6,209.79 | $11,518.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,348.75 / $8,054.81 / $12,323.40
| Facility | | $3,348.75 | $8,054.81 | $12,323.40 |