- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,758.00 / $12,596.00 / $17,425.09
| Facility | | $3,758.00 | $12,596.00 | $17,425.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,480.44 / $3,870.45
| Facility | | $1,146.00 | $2,480.44 | $3,870.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,740.97 / $6,550.57 / $12,150.37
| Facility | | $4,740.97 | $6,550.57 | $12,150.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,740.97 / $6,550.57 / $12,150.37
| Facility | | $4,740.97 | $6,550.57 | $12,150.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.52 / $8,384.10 / $12,999.67
| Facility | | $3,532.52 | $8,384.10 | $12,999.67 |