- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.00 / $19,329.70 / $26,740.40
| Facility | | $5,767.00 | $19,329.70 | $26,740.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,850.89
| Facility | | $1,146.00 | $3,000.00 | $5,850.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,275.45 / $10,052.45 / $18,645.86
| Facility | | $7,275.45 | $10,052.45 | $18,645.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,275.45 / $10,380.60 / $18,645.86
| Facility | | $7,275.45 | $10,380.60 | $18,645.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $12,866.18 / $19,949.21
| Facility | | $5,419.00 | $12,866.18 | $19,949.21 |