- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,896.00 / $16,410.30 / $22,701.80
| Facility | | $4,896.00 | $16,410.30 | $22,701.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $8,308.87
| Facility | | $1,146.00 | $3,000.00 | $8,308.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,176.63 / $8,534.21 / $15,829.75
| Facility | | $6,176.63 | $8,534.21 | $15,829.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,176.63 / $8,534.21 / $15,829.75
| Facility | | $6,176.63 | $8,534.21 | $15,829.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,602.24 / $10,922.98 / $16,936.24
| Facility | | $4,602.24 | $10,922.98 | $16,936.24 |