- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.00 / $14,097.60 / $19,502.40
| Facility | | $4,206.00 | $14,097.60 | $19,502.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,056.63
| Facility | | $1,146.00 | $3,000.00 | $7,056.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,306.15 / $7,331.48 / $13,598.84
| Facility | | $5,306.15 | $7,331.48 | $13,598.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,306.15 / $7,570.80 / $13,598.84
| Facility | | $5,306.15 | $7,570.80 | $13,598.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,953.64 / $9,383.59 / $14,549.40
| Facility | | $3,953.64 | $9,383.59 | $14,549.40 |