- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,348.00 / $14,573.60 / $20,160.80
| Facility | | $4,348.00 | $14,573.60 | $20,160.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,049.25 / $3,297.58
| Facility | | $1,146.00 | $2,049.25 | $3,297.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,485.29 / $7,579.00 / $14,057.95
| Facility | | $5,485.29 | $7,579.00 | $14,057.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,485.29 / $7,579.00 / $14,057.95
| Facility | | $5,485.29 | $7,579.00 | $14,057.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,087.12 / $9,700.39 / $15,040.60
| Facility | | $4,087.12 | $9,700.39 | $15,040.60 |