- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,821.00 / $10,665.60 / $19,488.40
| Facility | | $3,821.00 | $10,665.60 | $19,488.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,885.33 / $8,885.33 / $8,885.33
| Facility | | $8,885.33 | $8,885.33 | $8,885.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,991.63 / $13,594.09 / $22,992.57
| Facility | | $4,991.63 | $13,594.09 | $22,992.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,834.81 / $15,644.20 / $26,184.85
| Facility | | $10,834.81 | $15,644.20 | $26,184.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,415.90 / $17,459.13 / $25,491.75
| Facility | | $13,415.90 | $17,459.13 | $25,491.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,415.90 / $16,230.59 / $25,491.75
| Facility | | $13,415.90 | $16,230.59 | $25,491.75 |