- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,106.00 / $10,410.60 / $14,401.90
| Facility | | $3,106.00 | $10,410.60 | $14,401.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,493.40 / $3,887.66
| Facility | | $1,146.00 | $2,493.40 | $3,887.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,918.42 / $5,414.07 / $10,042.32
| Facility | | $3,918.42 | $5,414.07 | $10,042.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,918.42 / $5,414.07 / $10,042.32
| Facility | | $3,918.42 | $5,414.07 | $10,042.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $6,929.49 / $10,744.28
| Facility | | $3,036.00 | $6,929.49 | $10,744.28 |