- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,115.00 / $17,144.40 / $23,717.20
| Facility | | $5,115.00 | $17,144.40 | $23,717.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,144.77
| Facility | | $1,146.00 | $3,000.00 | $6,144.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,452.91 / $8,915.95 / $16,537.82
| Facility | | $6,452.91 | $8,915.95 | $16,537.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,452.91 / $8,915.95 / $16,537.82
| Facility | | $6,452.91 | $8,915.95 | $16,537.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,808.10 / $11,411.57 / $17,693.81
| Facility | | $4,808.10 | $11,411.57 | $17,693.81 |