- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,481.00 / $15,019.30 / $20,777.50
| Facility | | $4,481.00 | $15,019.30 | $20,777.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,765.10
| Facility | | $1,146.00 | $3,000.00 | $4,765.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,653.08 / $7,810.83 / $14,487.97
| Facility | | $5,653.08 | $7,810.83 | $14,487.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,653.08 / $7,810.83 / $14,487.97
| Facility | | $5,653.08 | $7,810.83 | $14,487.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,212.14 / $9,997.11 / $15,500.68
| Facility | | $4,212.14 | $9,997.11 | $15,500.68 |