- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,985.50 / $13,358.50 / $18,480.00
| Facility | | $3,985.50 | $13,358.50 | $18,480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,964.31
| Facility | | $1,146.00 | $3,000.00 | $7,964.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,027.97 / $6,947.13 / $12,885.92
| Facility | | $5,027.97 | $6,947.13 | $12,885.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,027.97 / $6,947.13 / $12,885.92
| Facility | | $5,027.97 | $6,947.13 | $12,885.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,746.37 / $8,891.65 / $13,786.64
| Facility | | $3,746.37 | $8,891.65 | $13,786.64 |