- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,872.00 / $16,329.90 / $22,590.50
| Facility | | $4,872.00 | $16,329.90 | $22,590.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,229.18
| Facility | | $1,146.00 | $3,000.00 | $5,229.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,146.35 / $8,492.37 / $15,752.15
| Facility | | $6,146.35 | $8,492.37 | $15,752.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,146.35 / $8,635.12 / $15,752.15
| Facility | | $6,146.35 | $8,635.12 | $15,752.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,579.68 / $10,869.43 / $16,853.22
| Facility | | $4,579.68 | $10,869.43 | $16,853.22 |