- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.50 / $16,797.50 / $23,237.30
| Facility | | $5,011.50 | $16,797.50 | $23,237.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $4,705.60
| Facility | | $1,146.00 | $3,000.00 | $4,705.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,322.34 / $8,735.54 / $16,203.18
| Facility | | $6,322.34 | $8,735.54 | $16,203.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,322.34 / $8,917.56 / $16,203.18
| Facility | | $6,322.34 | $8,917.56 | $16,203.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,710.81 / $11,180.66 / $17,335.78
| Facility | | $4,710.81 | $11,180.66 | $17,335.78 |