- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,796.00 / $19,426.90 / $26,874.90
| Facility | | $5,796.00 | $19,426.90 | $26,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $5,410.53
| Facility | | $1,146.00 | $3,000.00 | $5,410.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,312.04 / $10,103.01 / $18,739.63
| Facility | | $7,312.04 | $10,103.01 | $18,739.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,312.04 / $10,103.01 / $18,739.63
| Facility | | $7,312.04 | $10,103.01 | $18,739.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $12,930.88 / $20,049.52
| Facility | | $5,419.00 | $12,930.88 | $20,049.52 |