- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.50 / $14,015.50 / $19,388.80
| Facility | | $4,181.50 | $14,015.50 | $19,388.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,315.60 / $3,651.44
| Facility | | $1,146.00 | $2,315.60 | $3,651.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,275.24 / $7,288.77 / $13,519.63
| Facility | | $5,275.24 | $7,288.77 | $13,519.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,275.24 / $7,288.77 / $13,519.63
| Facility | | $5,275.24 | $7,288.77 | $13,519.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,930.61 / $10,550.98 / $14,464.64
| Facility | | $3,930.61 | $10,550.98 | $14,464.64 |