- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,273.50 / $10,972.10 / $15,178.60
| Facility | | $3,273.50 | $10,972.10 | $15,178.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,110.85 / $3,379.41
| Facility | | $1,146.00 | $2,110.85 | $3,379.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,129.74 / $5,706.04 / $10,583.88
| Facility | | $4,129.74 | $5,706.04 | $10,583.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,129.74 / $5,892.30 / $10,583.88
| Facility | | $4,129.74 | $5,892.30 | $10,583.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.09 / $7,303.18 / $11,323.69
| Facility | | $3,077.09 | $7,303.18 | $11,323.69 |