- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,126.00 / $13,829.50 / $19,131.40
| Facility | | $4,126.00 | $13,829.50 | $19,131.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,089.85 / $3,351.51
| Facility | | $1,146.00 | $2,089.85 | $3,351.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,205.22 / $7,192.03 / $13,340.18
| Facility | | $5,205.22 | $7,192.03 | $13,340.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,205.22 / $7,426.80 / $13,340.18
| Facility | | $5,205.22 | $7,426.80 | $13,340.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.44 / $9,328.89 / $14,688.56
| Facility | | $3,878.44 | $9,328.89 | $14,688.56 |