- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,835.00 / $19,557.70 / $27,055.70
| Facility | | $5,835.00 | $19,557.70 | $27,055.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,088.76
| Facility | | $1,146.00 | $3,000.00 | $5,088.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,361.24 / $10,170.99 / $18,865.72
| Facility | | $7,361.24 | $10,170.99 | $18,865.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,361.24 / $10,503.00 / $18,865.72
| Facility | | $7,361.24 | $10,503.00 | $18,865.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $7,128.00 / $20,184.43
| Facility | | $3,800.00 | $7,128.00 | $20,184.43 |