- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.56 / $6,600.00 / $26,835.70
| Facility | | $820.56 | $6,600.00 | $26,835.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,597.48 / $19,597.48 / $19,597.48
| Facility | | $19,597.48 | $19,597.48 | $19,597.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $20,917.84 / $33,116.57
| Facility | | $2,200.00 | $20,917.84 | $33,116.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,693.54 / $26,680.73 / $35,651.51
| Facility | | $17,693.54 | $26,680.73 | $35,651.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,681.37 / $29,622.36 / $44,232.02
| Facility | | $19,681.37 | $29,622.36 | $44,232.02 |