- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,500.00 / $16,982.30 / $24,807.00
| Facility | | $12,500.00 | $16,982.30 | $24,807.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,974.82 / $15,522.71 / $22,727.69
| Facility | | $9,974.82 | $15,522.71 | $22,727.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,904.65 / $15,295.66 / $27,248.00
| Facility | | $10,904.65 | $15,295.66 | $27,248.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.91 / $159.66 / $254.46
| Facility | | $115.91 | $159.66 | $254.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,010.92 / $16,622.64 / $27,356.99
| Facility | | $12,010.92 | $16,622.64 | $27,356.99 |