- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $12,653.00 / $17,503.90
| Facility | | $3,775.00 | $12,653.00 | $17,503.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,069.19
| Facility | | $1,146.00 | $3,000.00 | $7,069.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,762.41 / $6,580.20 / $12,205.33
| Facility | | $4,762.41 | $6,580.20 | $12,205.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,762.41 / $6,795.00 / $12,205.33
| Facility | | $4,762.41 | $6,795.00 | $12,205.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.50 / $9,551.98 / $13,058.48
| Facility | | $3,548.50 | $9,551.98 | $13,058.48 |