- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,215.00 / $14,127.80 / $19,544.09
| Facility | | $4,215.00 | $14,127.80 | $19,544.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,747.41
| Facility | | $1,146.00 | $3,000.00 | $6,747.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,317.50 / $7,347.17 / $13,627.94
| Facility | | $5,317.50 | $7,347.17 | $13,627.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,317.50 / $7,587.00 / $13,627.94
| Facility | | $5,317.50 | $7,587.00 | $13,627.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,962.10 / $9,403.67 / $14,580.53
| Facility | | $3,962.10 | $9,403.67 | $14,580.53 |