- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,076.00 / $10,863.70 / $14,147.70
| Facility | | $4,076.00 | $10,863.70 | $14,147.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.00 / $12,162.44 / $16,806.78
| Facility | | $3,092.00 | $12,162.44 | $16,806.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,784.00 / $10,272.70 / $15,288.54
| Facility | | $5,784.00 | $10,272.70 | $15,288.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,966.00 / $13,274.00 / $19,893.00
| Facility | | $8,966.00 | $13,274.00 | $19,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $14,556.84 / $19,229.91
| Facility | | $5,274.00 | $14,556.84 | $19,229.91 |