- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,900.06 / $16,391.59 / $21,988.00
| Facility | | $7,900.06 | $16,391.59 | $21,988.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,090.94 / $16,090.94 / $16,090.94
| Facility | | $16,090.94 | $16,090.94 | $16,090.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $20,069.18 / $23,863.18
| Facility | | $3,897.00 | $20,069.18 | $23,863.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,932.89 / $16,926.15 / $26,641.24
| Facility | | $13,932.89 | $16,926.15 | $26,641.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $20,911.81 / $30,003.83
| Facility | | $1,350.00 | $20,911.81 | $30,003.83 |