- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $16,933.20 / $23,425.10
| Facility | | $5,052.00 | $16,933.20 | $23,425.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $10,649.69
| Facility | | $1,146.00 | $3,000.00 | $10,649.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,373.43 / $8,806.14 / $16,334.13
| Facility | | $6,373.43 | $8,806.14 | $16,334.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,373.43 / $9,093.60 / $16,334.13
| Facility | | $6,373.43 | $9,093.60 | $16,334.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,748.88 / $11,271.01 / $17,475.88
| Facility | | $4,748.88 | $11,271.01 | $17,475.88 |