- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,389.00 / $9,770.17 / $15,956.30
| Facility | | $3,389.00 | $9,770.17 | $15,956.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,254.85 / $15,259.30 / $22,509.96
| Facility | | $11,254.85 | $15,259.30 | $22,509.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,163.28 / $12,925.42 / $20,353.41
| Facility | | $10,163.28 | $12,925.42 | $20,353.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,300.00 / $11,569.00 / $17,863.40
| Facility | | $4,300.00 | $11,569.00 | $17,863.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $13,006.12 / $17,863.40
| Facility | | $5,700.00 | $13,006.12 | $17,863.40 |