- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,318.00 / $11,121.20 / $15,384.90
| Facility | | $3,318.00 | $11,121.20 | $15,384.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,205.00 / $3,504.50
| Facility | | $1,146.00 | $2,205.00 | $3,504.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,185.88 / $5,783.61 / $10,727.76
| Facility | | $4,185.88 | $5,783.61 | $10,727.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,185.88 / $5,972.40 / $10,727.76
| Facility | | $4,185.88 | $5,972.40 | $10,727.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,118.92 / $7,402.46 / $11,477.63
| Facility | | $3,118.92 | $7,402.46 | $11,477.63 |