- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.18 / $12,917.10 / $16,719.59
| Facility | | $4,881.18 | $12,917.10 | $16,719.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,792.00 / $11,990.93 / $12,198.65
| Facility | | $5,792.00 | $11,990.93 | $12,198.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,823.00 / $13,269.96 / $21,702.70
| Facility | | $3,823.00 | $13,269.96 | $21,702.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $13,832.45 / $21,702.70
| Facility | | $3,800.00 | $13,832.45 | $21,702.70 |