- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.56 / $6,085.00 / $22,612.50
| Facility | | $820.56 | $6,085.00 | $22,612.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,500.20 / $15,500.20 / $21,521.26
| Facility | | $15,500.20 | $15,500.20 | $21,521.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $17,861.06 / $27,904.94
| Facility | | $2,200.00 | $17,861.06 | $27,904.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,909.06 / $22,481.92 / $30,400.54
| Facility | | $14,909.06 | $22,481.92 | $30,400.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,235.24 / $24,587.20 / $35,752.86
| Facility | | $16,235.24 | $24,587.20 | $35,752.86 |