- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,839.00 / $12,867.50 / $17,800.70
| Facility | | $3,839.00 | $12,867.50 | $17,800.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,120.30 / $3,391.97
| Facility | | $1,146.00 | $2,120.30 | $3,391.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,843.14 / $6,691.76 / $12,412.25
| Facility | | $4,843.14 | $6,691.76 | $12,412.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,843.14 / $6,691.76 / $12,412.25
| Facility | | $4,843.14 | $6,691.76 | $12,412.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.66 / $8,564.81 / $13,279.87
| Facility | | $3,608.66 | $8,564.81 | $13,279.87 |