- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,513.50 / $15,128.30 / $20,928.20
| Facility | | $4,513.50 | $15,128.30 | $20,928.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,987.10
| Facility | | $1,146.00 | $3,000.00 | $7,987.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,694.08 / $7,867.48 / $14,593.05
| Facility | | $5,694.08 | $7,867.48 | $14,593.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,694.08 / $7,867.48 / $14,593.05
| Facility | | $5,694.08 | $7,867.48 | $14,593.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,242.68 / $11,566.00 / $15,613.10
| Facility | | $4,242.68 | $11,566.00 | $15,613.10 |