- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,847.00 / $12,894.30 / $17,837.80
| Facility | | $3,847.00 | $12,894.30 | $17,837.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $1,681.75 / $3,000.00
| Facility | | $1,146.00 | $1,681.75 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,853.24 / $6,705.71 / $12,438.12
| Facility | | $4,853.24 | $6,705.71 | $12,438.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,853.24 / $6,705.71 / $12,438.12
| Facility | | $4,853.24 | $6,705.71 | $12,438.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,616.18 / $8,582.66 / $13,307.54
| Facility | | $3,616.18 | $8,582.66 | $13,307.54 |