- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,445.00 / $11,546.90 / $15,973.80
| Facility | | $3,445.00 | $11,546.90 | $15,973.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,689.05 / $4,147.59
| Facility | | $1,146.00 | $2,689.05 | $4,147.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.09 / $6,004.98 / $11,138.37
| Facility | | $4,346.09 | $6,004.98 | $11,138.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.09 / $6,107.88 / $11,138.37
| Facility | | $4,346.09 | $6,107.88 | $11,138.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,238.30 / $7,685.80 / $11,916.94
| Facility | | $3,238.30 | $7,685.80 | $11,916.94 |