- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,396.00 / $18,086.20 / $25,020.20
| Facility | | $5,396.00 | $18,086.20 | $25,020.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $2,267.65 / $3,587.74
| Facility | | $1,146.00 | $2,267.65 | $3,587.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,807.41 / $9,405.77 / $17,446.34
| Facility | | $6,807.41 | $9,405.77 | $17,446.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,807.41 / $9,712.79 / $17,446.34
| Facility | | $6,807.41 | $9,712.79 | $17,446.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $7,128.00 / $18,665.84
| Facility | | $3,800.00 | $7,128.00 | $18,665.84 |