- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,691.00 / $12,371.40 / $17,114.40
| Facility | | $3,691.00 | $12,371.40 | $17,114.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,172.10 / $3,460.79
| Facility | | $1,146.00 | $2,172.10 | $3,460.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,656.43 / $6,433.78 / $11,933.74
| Facility | | $4,656.43 | $6,433.78 | $11,933.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,656.43 / $6,433.78 / $11,933.74
| Facility | | $4,656.43 | $6,433.78 | $11,933.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,469.54 / $8,234.62 / $12,767.91
| Facility | | $3,469.54 | $8,234.62 | $12,767.91 |