- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.18 / $11,073.00 / $14,332.70
| Facility | | $4,881.18 | $11,073.00 | $14,332.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,792.00 / $10,279.11 / $10,457.18
| Facility | | $5,792.00 | $10,279.11 | $10,457.18 |
- 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 / $11,375.55 / $18,604.43
| Facility | | $3,823.00 | $11,375.55 | $18,604.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $11,857.74 / $18,604.43
| Facility | | $3,800.00 | $11,857.74 | $18,604.43 |