- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,389.00 / $9,752.85 / $15,928.10
| Facility | | $3,389.00 | $9,752.85 | $15,928.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,234.90 / $15,232.25 / $22,470.05
| Facility | | $11,234.90 | $15,232.25 | $22,470.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,145.26 / $12,546.62 / $20,317.32
| Facility | | $10,145.26 | $12,546.62 | $20,317.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,515.00 / $17,831.73
| Facility | | $3,300.00 | $9,515.00 | $17,831.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,744.00 / $17,985.82
| Facility | | $3,300.00 | $9,744.00 | $17,985.82 |