- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,258.00 / $14,271.90 / $19,743.50
| Facility | | $4,258.00 | $14,271.90 | $19,743.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,523.07
| Facility | | $1,146.00 | $3,000.00 | $5,523.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,371.75 / $7,422.12 / $13,766.97
| Facility | | $5,371.75 | $7,422.12 | $13,766.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,371.75 / $7,664.40 / $13,766.97
| Facility | | $5,371.75 | $7,664.40 | $13,766.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,002.52 / $9,499.60 / $14,729.27
| Facility | | $4,002.52 | $9,499.60 | $14,729.27 |