- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,389.00 / $10,190.00 / $19,421.20
| Facility | | $3,389.00 | $10,190.00 | $19,421.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,698.81 / $18,572.81 / $27,397.92
| Facility | | $13,698.81 | $18,572.81 | $27,397.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,370.20 / $15,298.20 / $24,773.08
| Facility | | $12,370.20 | $15,298.20 | $24,773.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $10,862.00 / $21,742.38
| Facility | | $3,300.00 | $10,862.00 | $21,742.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $10,862.00 / $21,930.26
| Facility | | $3,300.00 | $10,862.00 | $21,930.26 |