- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,150.50 / $13,911.60 / $19,245.00
| Facility | | $4,150.50 | $13,911.60 | $19,245.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $8,348.40
| Facility | | $1,146.00 | $3,000.00 | $8,348.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,236.13 / $7,234.74 / $13,419.40
| Facility | | $5,236.13 | $7,234.74 | $13,419.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,236.13 / $7,234.74 / $13,419.40
| Facility | | $5,236.13 | $7,234.74 | $13,419.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,901.47 / $9,259.77 / $14,357.41
| Facility | | $3,901.47 | $9,259.77 | $14,357.41 |