- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,773.00 / $12,646.30 / $17,494.59
| Facility | | $3,773.00 | $12,646.30 | $17,494.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,709.96
| Facility | | $1,146.00 | $3,000.00 | $7,709.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,759.89 / $6,576.72 / $12,198.86
| Facility | | $4,759.89 | $6,576.72 | $12,198.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,759.89 / $6,791.40 / $12,198.86
| Facility | | $4,759.89 | $6,791.40 | $12,198.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,546.62 / $8,417.56 / $13,051.56
| Facility | | $3,546.62 | $8,417.56 | $13,051.56 |