- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,990.00 / $10,561.00 / $18,563.00
| Facility | | $4,990.00 | $10,561.00 | $18,563.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,683.17 / $18,587.58 / $25,042.75
| Facility | | $12,683.17 | $18,587.58 | $25,042.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,575.26 / $16,322.09 / $23,400.90
| Facility | | $11,575.26 | $16,322.09 | $23,400.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,205.40 / $15,766.88 / $33,063.64
| Facility | | $8,205.40 | $15,766.88 | $33,063.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,575.26 / $17,633.16 / $23,406.68
| Facility | | $11,575.26 | $17,633.16 | $23,406.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,634.60 / $14,069.00 / $20,612.05
| Facility | | $4,634.60 | $14,069.00 | $20,612.05 |