- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,247.00 / $14,235.00 / $19,692.50
| Facility | | $4,247.00 | $14,235.00 | $19,692.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,132.68
| Facility | | $1,146.00 | $3,000.00 | $6,132.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,357.87 / $7,402.95 / $13,731.40
| Facility | | $5,357.87 | $7,402.95 | $13,731.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,357.87 / $7,402.95 / $13,731.40
| Facility | | $5,357.87 | $7,402.95 | $13,731.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,992.18 / $9,475.06 / $14,691.22
| Facility | | $3,992.18 | $9,475.06 | $14,691.22 |