- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,880.00 / $16,356.70 / $22,627.60
| Facility | | $4,880.00 | $16,356.70 | $22,627.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $10,219.10
| Facility | | $1,146.00 | $3,000.00 | $10,219.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,156.44 / $8,506.33 / $15,778.02
| Facility | | $6,156.44 | $8,506.33 | $15,778.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,156.44 / $8,784.00 / $15,778.02
| Facility | | $6,156.44 | $8,784.00 | $15,778.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,587.20 / $10,887.28 / $16,880.90
| Facility | | $4,587.20 | $10,887.28 | $16,880.90 |