- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,586.00 / $12,019.50 / $16,627.59
| Facility | | $3,586.00 | $12,019.50 | $16,627.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,577.01
| Facility | | $1,146.00 | $3,000.00 | $5,577.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,523.97 / $6,250.76 / $11,594.26
| Facility | | $4,523.97 | $6,250.76 | $11,594.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,523.97 / $6,454.80 / $11,594.26
| Facility | | $4,523.97 | $6,454.80 | $11,594.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,370.84 / $8,000.37 / $12,404.69
| Facility | | $3,370.84 | $8,000.37 | $12,404.69 |