- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.20 / $10,466.40 / $17,517.00
| Facility | | $7,585.20 | $10,466.40 | $17,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,242.07 / $16,242.07 / $20,255.50
| Facility | | $16,242.07 | $16,242.07 | $20,255.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $12,113.06 / $18,314.32
| Facility | | $2,423.00 | $12,113.06 | $18,314.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.20 / $11,775.12 / $19,746.80
| Facility | | $7,585.20 | $11,775.12 | $19,746.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $9,503.17 / $21,131.40
| Facility | | $2,600.00 | $9,503.17 | $21,131.40 |