- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,037.00 / $13,531.20 / $18,718.80
| Facility | | $4,037.00 | $13,531.20 | $18,718.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,883.30 / $4,405.67
| Facility | | $1,146.00 | $2,883.30 | $4,405.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,092.93 / $7,036.89 / $13,052.43
| Facility | | $5,092.93 | $7,036.89 | $13,052.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,092.93 / $7,036.89 / $13,052.43
| Facility | | $5,092.93 | $7,036.89 | $13,052.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,794.78 / $9,006.54 / $13,964.79
| Facility | | $3,794.78 | $9,006.54 | $13,964.79 |