- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,841.50 / $12,875.90 / $17,812.30
| Facility | | $3,841.50 | $12,875.90 | $17,812.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,416.58
| Facility | | $1,146.00 | $3,000.00 | $5,416.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,846.31 / $6,696.12 / $12,420.34
| Facility | | $4,846.31 | $6,696.12 | $12,420.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,846.31 / $6,696.12 / $12,420.34
| Facility | | $4,846.31 | $6,696.12 | $12,420.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,611.01 / $8,570.39 / $13,288.52
| Facility | | $3,611.01 | $8,570.39 | $13,288.52 |