- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,245.00 / $14,228.30 / $19,683.20
| Facility | | $4,245.00 | $14,228.30 | $19,683.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,322.86
| Facility | | $1,146.00 | $3,000.00 | $6,322.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,355.35 / $7,399.46 / $13,724.93
| Facility | | $5,355.35 | $7,399.46 | $13,724.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,355.35 / $7,641.00 / $13,724.93
| Facility | | $5,355.35 | $7,641.00 | $13,724.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,990.30 / $9,470.60 / $14,684.30
| Facility | | $3,990.30 | $9,470.60 | $14,684.30 |