- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.00 / $14,013.80 / $19,386.50
| Facility | | $4,181.00 | $14,013.80 | $19,386.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,399.94 / $3,763.51
| Facility | | $1,146.00 | $2,399.94 | $3,763.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.61 / $7,287.90 / $13,518.01
| Facility | | $5,274.61 | $7,287.90 | $13,518.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.61 / $7,287.90 / $13,518.01
| Facility | | $5,274.61 | $7,287.90 | $13,518.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,930.14 / $9,327.81 / $14,462.92
| Facility | | $3,930.14 | $9,327.81 | $14,462.92 |