- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $8,766.66 / $15,023.70
| Facility | | $2,310.00 | $8,766.66 | $15,023.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,049.45 / $10,049.45 / $20,818.66
| Facility | | $10,049.45 | $10,049.45 | $20,818.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.00 / $12,674.74 / $14,929.20
| Facility | | $3,548.00 | $12,674.74 | $14,929.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $10,999.44 / $17,147.00
| Facility | | $5,616.00 | $10,999.44 | $17,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $12,668.71 / $18,007.78
| Facility | | $5,616.00 | $12,668.71 | $18,007.78 |