- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,442.00 / $11,536.80 / $15,959.90
| Facility | | $3,442.00 | $11,536.80 | $15,959.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,487.10 / $3,879.29
| Facility | | $1,146.00 | $2,487.10 | $3,879.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,342.31 / $5,999.75 / $11,128.67
| Facility | | $4,342.31 | $5,999.75 | $11,128.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,342.31 / $6,106.04 / $11,128.67
| Facility | | $4,342.31 | $6,106.04 | $11,128.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.48 / $7,679.10 / $11,906.57
| Facility | | $3,235.48 | $7,679.10 | $11,906.57 |