- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,513.00 / $15,126.60 / $20,925.90
| Facility | | $4,513.00 | $15,126.60 | $20,925.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,814.35 / $4,314.07
| Facility | | $1,146.00 | $2,814.35 | $4,314.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.45 / $7,866.61 / $14,591.43
| Facility | | $5,693.45 | $7,866.61 | $14,591.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.45 / $7,866.61 / $14,591.43
| Facility | | $5,693.45 | $7,866.61 | $14,591.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,242.22 / $10,068.50 / $15,611.37
| Facility | | $4,242.22 | $10,068.50 | $15,611.37 |