- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,746.50 / $12,557.50 / $17,371.80
| Facility | | $3,746.50 | $12,557.50 | $17,371.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,337.65 / $3,680.74
| Facility | | $1,146.00 | $2,337.65 | $3,680.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.46 / $6,530.52 / $12,113.18
| Facility | | $4,726.46 | $6,530.52 | $12,113.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.46 / $6,530.52 / $12,113.18
| Facility | | $4,726.46 | $6,530.52 | $12,113.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,521.71 / $8,358.44 / $12,959.89
| Facility | | $3,521.71 | $8,358.44 | $12,959.89 |