- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,389.00 / $10,190.00 / $16,876.50
| Facility | | $3,389.00 | $10,190.00 | $16,876.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,668.17 / $17,175.47 / $25,336.62
| Facility | | $12,668.17 | $17,175.47 | $25,336.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,439.52 / $14,147.23 / $22,909.26
| Facility | | $11,439.52 | $14,147.23 | $22,909.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $10,360.32 / $20,106.58
| Facility | | $3,300.00 | $10,360.32 | $20,106.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $10,360.32 / $20,280.33
| Facility | | $3,300.00 | $10,360.32 | $20,280.33 |