- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,002.50 / $13,415.50 / $18,558.80
| Facility | | $4,002.50 | $13,415.50 | $18,558.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,864.16
| Facility | | $1,146.00 | $3,000.00 | $4,864.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.42 / $6,976.76 / $12,940.88
| Facility | | $5,049.42 | $6,976.76 | $12,940.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.42 / $6,976.76 / $12,940.88
| Facility | | $5,049.42 | $6,976.76 | $12,940.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,762.35 / $8,929.58 / $13,845.45
| Facility | | $3,762.35 | $8,929.58 | $13,845.45 |