- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $11,843.00 / $16,654.09
| Facility | | $4,098.00 | $11,843.00 | $16,654.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,143.00 / $9,315.00 / $14,782.81
| Facility | | $4,143.00 | $9,315.00 | $14,782.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,197.28 / $15,538.96 / $21,659.52
| Facility | | $10,197.28 | $15,538.96 | $21,659.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.00 / $8,512.00 / $8,512.00
| Facility | | $8,512.00 | $8,512.00 | $8,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,962.00 / $13,749.00 / $19,227.50
| Facility | | $8,962.00 | $13,749.00 | $19,227.50 |