- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,601.50 / $12,071.50 / $16,699.40
| Facility | | $3,601.50 | $12,071.50 | $16,699.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,631.30 / $4,070.87
| Facility | | $1,146.00 | $2,631.30 | $4,070.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,543.53 / $6,277.77 / $11,644.37
| Facility | | $4,543.53 | $6,277.77 | $11,644.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,543.53 / $6,277.77 / $11,644.37
| Facility | | $4,543.53 | $6,277.77 | $11,644.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,385.41 / $8,034.95 / $12,458.31
| Facility | | $3,385.41 | $8,034.95 | $12,458.31 |