- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,891.00 / $13,041.80 / $18,041.80
| Facility | | $3,891.00 | $13,041.80 | $18,041.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,952.97
| Facility | | $1,146.00 | $3,000.00 | $4,952.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,908.75 / $6,782.40 / $12,580.38
| Facility | | $4,908.75 | $6,782.40 | $12,580.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,908.75 / $6,782.40 / $12,580.38
| Facility | | $4,908.75 | $6,782.40 | $12,580.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,657.54 / $8,680.82 / $13,459.75
| Facility | | $3,657.54 | $8,680.82 | $13,459.75 |