- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $10,188.87 / $19,933.30
| Facility | | $2,310.00 | $10,188.87 | $19,933.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,393.19 / $22,393.19 / $22,393.19
| Facility | | $22,393.19 | $22,393.19 | $22,393.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,792.00 / $10,034.01 / $18,885.55
| Facility | | $5,792.00 | $10,034.01 | $18,885.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $14,717.61 / $20,568.22
| Facility | | $5,616.00 | $14,717.61 | $20,568.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $16,808.72 / $23,892.55
| Facility | | $5,616.00 | $16,808.72 | $23,892.55 |