- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,856.00 / $16,276.30 / $22,516.30
| Facility | | $4,856.00 | $16,276.30 | $22,516.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,126.42
| Facility | | $1,146.00 | $3,000.00 | $5,126.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,126.16 / $8,464.49 / $15,700.42
| Facility | | $6,126.16 | $8,464.49 | $15,700.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,126.16 / $8,464.49 / $15,700.42
| Facility | | $6,126.16 | $8,464.49 | $15,700.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,564.64 / $11,996.75 / $16,797.88
| Facility | | $4,564.64 | $11,996.75 | $16,797.88 |