- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,153.00 / $13,920.00 / $19,256.59
| Facility | | $4,153.00 | $13,920.00 | $19,256.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,014.25 / $3,251.08
| Facility | | $1,146.00 | $2,014.25 | $3,251.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,239.28 / $7,239.09 / $13,427.48
| Facility | | $5,239.28 | $7,239.09 | $13,427.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,239.28 / $7,239.09 / $13,427.48
| Facility | | $5,239.28 | $7,239.09 | $13,427.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,903.82 / $10,132.76 / $14,366.06
| Facility | | $3,903.82 | $10,132.76 | $14,366.06 |