- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,130.00 / $17,194.70 / $23,786.80
| Facility | | $5,130.00 | $17,194.70 | $23,786.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $11,049.13
| Facility | | $1,146.00 | $3,000.00 | $11,049.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,471.83 / $8,942.10 / $16,586.32
| Facility | | $6,471.83 | $8,942.10 | $16,586.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,471.83 / $9,234.00 / $16,586.32
| Facility | | $6,471.83 | $9,234.00 | $16,586.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,822.20 / $11,598.93 / $17,745.70
| Facility | | $4,822.20 | $11,598.93 | $17,745.70 |