- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,591.00 / $15,388.00 / $21,287.50
| Facility | | $4,591.00 | $15,388.00 | $21,287.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,930.90 / $4,468.91
| Facility | | $1,146.00 | $2,930.90 | $4,468.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,791.85 / $8,002.57 / $14,843.62
| Facility | | $5,791.85 | $8,002.57 | $14,843.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,791.85 / $8,002.57 / $14,843.62
| Facility | | $5,791.85 | $8,002.57 | $14,843.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,315.54 / $10,242.52 / $15,881.19
| Facility | | $4,315.54 | $10,242.52 | $15,881.19 |