- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,287.00 / $17,720.90 / $24,514.80
| Facility | | $5,287.00 | $17,720.90 | $24,514.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,805.78
| Facility | | $1,146.00 | $3,000.00 | $5,805.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,669.90 / $9,215.77 / $17,093.93
| Facility | | $6,669.90 | $9,215.77 | $17,093.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,424.36 / $9,215.77 / $17,093.93
| Facility | | $6,424.36 | $9,215.77 | $17,093.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,969.78 / $11,795.30 / $18,288.79
| Facility | | $4,969.78 | $11,795.30 | $18,288.79 |