- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,994.00 / $13,387.00 / $18,519.40
| Facility | | $3,994.00 | $13,387.00 | $18,519.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,637.20
| Facility | | $1,146.00 | $3,000.00 | $6,637.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,038.68 / $6,961.94 / $12,913.40
| Facility | | $5,038.68 | $6,961.94 | $12,913.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,038.68 / $6,961.94 / $12,913.40
| Facility | | $5,038.68 | $6,961.94 | $12,913.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,754.36 / $8,910.61 / $13,816.04
| Facility | | $3,754.36 | $8,910.61 | $13,816.04 |