- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,898.00 / $13,065.30 / $18,074.20
| Facility | | $3,898.00 | $13,065.30 | $18,074.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,497.60 / $3,893.24
| Facility | | $1,146.00 | $2,497.60 | $3,893.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.58 / $6,794.60 / $12,603.01
| Facility | | $4,917.58 | $6,794.60 | $12,603.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.58 / $6,794.60 / $12,603.01
| Facility | | $4,917.58 | $6,794.60 | $12,603.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,664.12 / $8,696.44 / $13,483.96
| Facility | | $3,664.12 | $8,696.44 | $13,483.96 |