- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $11,670.00 / $18,306.40
| Facility | | $1,650.00 | $11,670.00 | $18,306.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,097.06 / $13,776.77 / $18,554.00
| Facility | | $8,097.06 | $13,776.77 | $18,554.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,909.20 / $14,572.80 / $24,760.05
| Facility | | $9,909.20 | $14,572.80 | $24,760.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,716.00 / $14,097.00 / $18,717.00
| Facility | | $10,716.00 | $14,097.00 | $18,717.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,044.00 / $12,881.00 / $24,596.10
| Facility | | $4,044.00 | $12,881.00 | $24,596.10 |