- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,011.50 / $20,149.20 / $27,874.10
| Facility | | $6,011.50 | $20,149.20 | $27,874.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,523.50 / $3,927.65
| Facility | | $1,146.00 | $2,523.50 | $3,927.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,583.90 / $10,478.65 / $19,436.38
| Facility | | $7,583.90 | $10,478.65 | $19,436.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,583.90 / $10,478.65 / $19,436.38
| Facility | | $7,583.90 | $10,478.65 | $19,436.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $13,411.66 / $20,794.98
| Facility | | $5,419.00 | $13,411.66 | $20,794.98 |