- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,637.00 / $12,190.40 / $16,864.00
| Facility | | $3,637.00 | $12,190.40 | $16,864.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,280.34
| Facility | | $1,146.00 | $3,000.00 | $5,280.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,588.32 / $6,339.65 / $11,759.15
| Facility | | $4,588.32 | $6,339.65 | $11,759.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,588.32 / $6,546.60 / $11,759.15
| Facility | | $4,588.32 | $6,546.60 | $11,759.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,418.78 / $9,000.96 / $12,581.11
| Facility | | $3,418.78 | $9,000.96 | $12,581.11 |