- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,389.00 / $10,190.00 / $16,648.70
| Facility | | $3,389.00 | $10,190.00 | $16,648.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,743.18 / $15,921.37 / $23,486.61
| Facility | | $11,743.18 | $15,921.37 | $23,486.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,604.24 / $13,114.24 / $21,236.49
| Facility | | $10,604.24 | $13,114.24 | $21,236.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,608.00 / $18,638.45
| Facility | | $3,300.00 | $9,608.00 | $18,638.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,803.92 / $18,799.52
| Facility | | $3,300.00 | $9,803.92 | $18,799.52 |