- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,358.00 / $14,607.10 / $20,207.20
| Facility | | $4,358.00 | $14,607.10 | $20,207.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,782.50 / $4,271.75
| Facility | | $1,146.00 | $2,782.50 | $4,271.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,497.90 / $7,596.43 / $14,090.29
| Facility | | $5,497.90 | $7,596.43 | $14,090.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,497.90 / $7,596.43 / $14,090.29
| Facility | | $5,497.90 | $7,596.43 | $14,090.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,096.52 / $9,722.70 / $15,075.19
| Facility | | $4,096.52 | $9,722.70 | $15,075.19 |