- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,706.27 / $11,945.20 / $15,461.70
| Facility | | $4,706.27 | $11,945.20 | $15,461.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.00 / $11,088.78 / $11,280.88
| Facility | | $3,548.00 | $11,088.78 | $11,280.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,823.00 / $12,271.58 / $20,069.88
| Facility | | $3,823.00 | $12,271.58 | $20,069.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $12,791.76 / $20,069.88
| Facility | | $3,800.00 | $12,791.76 | $20,069.88 |