- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.00 / $21,702.80 / $30,023.30
| Facility | | $6,475.00 | $21,702.80 | $30,023.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $10,286.06
| Facility | | $1,146.00 | $3,000.00 | $10,286.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,168.64 / $11,286.57 / $20,934.97
| Facility | | $8,168.64 | $11,286.57 | $20,934.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,168.64 / $11,655.00 / $20,934.97
| Facility | | $8,168.64 | $11,655.00 | $20,934.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $14,445.73 / $22,398.32
| Facility | | $5,419.00 | $14,445.73 | $22,398.32 |