- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $16,219.60 / $21,757.20
| Facility | | $3,000.00 | $16,219.60 | $21,757.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,187.41 / $22,193.87 / $30,836.52
| Facility | | $17,187.41 | $22,193.87 | $30,836.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $18,917.00 / $18,917.00
| Facility | | $3,897.00 | $18,917.00 | $18,917.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,786.66 / $16,748.50 / $26,361.63
| Facility | | $13,786.66 | $16,748.50 | $26,361.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $20,692.33 / $29,688.92
| Facility | | $1,350.00 | $20,692.33 | $29,688.92 |