- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,582.50 / $15,359.50 / $21,248.10
| Facility | | $4,582.50 | $15,359.50 | $21,248.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,616.32
| Facility | | $1,146.00 | $3,000.00 | $4,616.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,781.13 / $7,987.76 / $14,816.14
| Facility | | $5,781.13 | $7,987.76 | $14,816.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,781.13 / $8,248.50 / $14,816.14
| Facility | | $5,781.13 | $8,248.50 | $14,816.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,307.55 / $10,223.56 / $15,851.78
| Facility | | $4,307.55 | $10,223.56 | $15,851.78 |