- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,001.50 / $10,060.40 / $13,917.40
| Facility | | $3,001.50 | $10,060.40 | $13,917.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $8,060.57
| Facility | | $1,146.00 | $3,000.00 | $8,060.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,786.59 / $5,231.91 / $9,704.45
| Facility | | $3,786.59 | $5,231.91 | $9,704.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,786.59 / $5,402.70 / $9,704.45
| Facility | | $3,786.59 | $5,402.70 | $9,704.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.00 / $6,696.35 / $10,382.79
| Facility | | $3,036.00 | $6,696.35 | $10,382.79 |