- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,239.00 / $17,560.00 / $24,292.20
| Facility | | $5,239.00 | $17,560.00 | $24,292.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $11,109.11
| Facility | | $1,146.00 | $3,000.00 | $11,109.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,609.34 / $9,132.10 / $16,938.73
| Facility | | $6,609.34 | $9,132.10 | $16,938.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,609.34 / $9,430.20 / $16,938.73
| Facility | | $6,609.34 | $9,430.20 | $16,938.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,924.66 / $11,688.21 / $18,122.75
| Facility | | $4,924.66 | $11,688.21 | $18,122.75 |