- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.00 / $12,093.20 / $16,729.59
| Facility | | $3,608.00 | $12,093.20 | $16,729.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $1,926.05 / $3,133.89
| Facility | | $1,146.00 | $1,926.05 | $3,133.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,551.72 / $6,289.10 / $11,665.39
| Facility | | $4,551.72 | $6,289.10 | $11,665.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,551.72 / $6,289.10 / $11,665.39
| Facility | | $4,551.72 | $6,289.10 | $11,665.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,391.52 / $8,049.45 / $12,480.79
| Facility | | $3,391.52 | $8,049.45 | $12,480.79 |