- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,472.00 / $18,341.00 / $25,372.60
| Facility | | $5,472.00 | $18,341.00 | $25,372.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,816.27
| Facility | | $1,146.00 | $3,000.00 | $4,816.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,903.29 / $9,538.24 / $17,692.07
| Facility | | $6,903.29 | $9,538.24 | $17,692.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,903.29 / $9,849.60 / $17,692.07
| Facility | | $6,903.29 | $9,849.60 | $17,692.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,143.68 / $12,208.03 / $18,928.74
| Facility | | $5,143.68 | $12,208.03 | $18,928.74 |