- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,056.00 / $13,594.80 / $18,806.90
| Facility | | $4,056.00 | $13,594.80 | $18,806.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,605.75 / $4,036.93
| Facility | | $1,146.00 | $2,605.75 | $4,036.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.91 / $7,070.01 / $13,113.86
| Facility | | $5,116.91 | $7,070.01 | $13,113.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.91 / $7,103.32 / $13,113.86
| Facility | | $5,116.91 | $7,103.32 | $13,113.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,812.64 / $9,048.94 / $14,030.52
| Facility | | $3,812.64 | $9,048.94 | $14,030.52 |