- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,911.00 / $19,812.40 / $27,408.10
| Facility | | $5,911.00 | $19,812.40 | $27,408.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,329.25 / $3,669.57
| Facility | | $1,146.00 | $2,329.25 | $3,669.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,457.12 / $10,303.45 / $19,111.45
| Facility | | $7,457.12 | $10,303.45 | $19,111.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,457.12 / $10,303.45 / $19,111.45
| Facility | | $7,457.12 | $10,303.45 | $19,111.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $13,187.44 / $20,447.33
| Facility | | $5,419.00 | $13,187.44 | $20,447.33 |