- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,029.50 / $13,506.00 / $18,684.00
| Facility | | $4,029.50 | $13,506.00 | $18,684.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,871.10
| Facility | | $1,146.00 | $3,000.00 | $6,871.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,083.47 / $7,023.82 / $13,028.18
| Facility | | $5,083.47 | $7,023.82 | $13,028.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,083.47 / $7,253.10 / $13,028.18
| Facility | | $5,083.47 | $7,253.10 | $13,028.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,787.73 / $8,989.81 / $13,938.85
| Facility | | $3,787.73 | $8,989.81 | $13,938.85 |