- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,431.00 / $14,851.80 / $20,545.70
| Facility | | $4,431.00 | $14,851.80 | $20,545.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,172.45
| Facility | | $1,146.00 | $3,000.00 | $5,172.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,590.00 / $7,723.68 / $14,326.31
| Facility | | $5,590.00 | $7,723.68 | $14,326.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,590.00 / $7,723.68 / $14,326.31
| Facility | | $5,590.00 | $7,723.68 | $14,326.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,165.14 / $9,885.56 / $15,327.72
| Facility | | $4,165.14 | $9,885.56 | $15,327.72 |