- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,781.00 / $12,673.10 / $17,531.70
| Facility | | $3,781.00 | $12,673.10 | $17,531.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,612.31
| Facility | | $1,146.00 | $3,000.00 | $7,612.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.97 / $6,590.66 / $12,224.73
| Facility | | $4,769.97 | $6,590.66 | $12,224.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.97 / $6,805.80 / $12,224.73
| Facility | | $4,769.97 | $6,805.80 | $12,224.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.14 / $8,435.41 / $13,079.24
| Facility | | $3,554.14 | $8,435.41 | $13,079.24 |