- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,412.00 / $28,195.20 / $39,004.80
| Facility | | $8,412.00 | $28,195.20 | $39,004.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,870.17
| Facility | | $1,146.00 | $3,000.00 | $6,870.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,612.29 / $14,662.96 / $27,197.68
| Facility | | $10,612.29 | $14,662.96 | $27,197.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,612.29 / $14,697.92 / $27,197.68
| Facility | | $10,612.29 | $14,697.92 | $27,197.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $18,767.16 / $29,098.79
| Facility | | $5,419.00 | $18,767.16 | $29,098.79 |