- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,731.50 / $19,210.80 / $26,575.80
| Facility | | $5,731.50 | $19,210.80 | $26,575.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,142.66
| Facility | | $1,146.00 | $3,000.00 | $7,142.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,230.67 / $9,990.58 / $18,531.09
| Facility | | $7,230.67 | $9,990.58 | $18,531.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,230.67 / $9,990.58 / $18,531.09
| Facility | | $7,230.67 | $9,990.58 | $18,531.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,387.61 / $12,786.98 / $19,826.40
| Facility | | $5,387.61 | $12,786.98 | $19,826.40 |