- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,353.00 / $14,590.30 / $20,184.00
| Facility | | $4,353.00 | $14,590.30 | $20,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,875.32
| Facility | | $1,146.00 | $3,000.00 | $4,875.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,491.60 / $7,587.71 / $14,074.12
| Facility | | $5,491.60 | $7,587.71 | $14,074.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,491.60 / $7,675.56 / $14,074.12
| Facility | | $5,491.60 | $7,675.56 | $14,074.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,091.82 / $9,711.54 / $15,057.90
| Facility | | $4,091.82 | $9,711.54 | $15,057.90 |