- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,389.00 / $18,062.80 / $24,987.70
| Facility | | $5,389.00 | $18,062.80 | $24,987.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $6,319.61
| Facility | | $1,146.00 | $3,000.00 | $6,319.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,798.58 / $9,393.57 / $17,423.71
| Facility | | $6,798.58 | $9,393.57 | $17,423.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,798.58 / $9,393.57 / $17,423.71
| Facility | | $6,798.58 | $9,393.57 | $17,423.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,065.66 / $12,022.86 / $18,641.63
| Facility | | $5,065.66 | $12,022.86 | $18,641.63 |