- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,895.00 / $16,407.00 / $22,697.10
| Facility | | $4,895.00 | $16,407.00 | $22,697.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,796.50 / $4,290.35
| Facility | | $1,146.00 | $2,796.50 | $4,290.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,175.37 / $8,532.46 / $15,826.51
| Facility | | $6,175.37 | $8,532.46 | $15,826.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,175.37 / $8,811.00 / $15,826.51
| Facility | | $6,175.37 | $8,811.00 | $15,826.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,601.30 / $10,920.75 / $16,932.78
| Facility | | $4,601.30 | $10,920.75 | $16,932.78 |