- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,098.00 / $17,087.40 / $23,638.40
| Facility | | $5,098.00 | $17,087.40 | $23,638.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $7,108.25
| Facility | | $1,146.00 | $3,000.00 | $7,108.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.46 / $8,886.32 / $16,482.84
| Facility | | $6,431.46 | $8,886.32 | $16,482.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.46 / $9,176.40 / $16,482.84
| Facility | | $6,431.46 | $9,176.40 | $16,482.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,792.12 / $11,373.64 / $17,635.00
| Facility | | $4,792.12 | $11,373.64 | $17,635.00 |