- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,886.50 / $16,378.50 / $22,657.70
| Facility | | $4,886.50 | $16,378.50 | $22,657.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,349.15
| Facility | | $1,146.00 | $3,000.00 | $5,349.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.64 / $8,517.66 / $15,799.03
| Facility | | $6,164.64 | $8,517.66 | $15,799.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.64 / $8,517.66 / $15,799.03
| Facility | | $6,164.64 | $8,517.66 | $15,799.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,593.31 / $11,510.72 / $16,903.38
| Facility | | $4,593.31 | $11,510.72 | $16,903.38 |