- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $10,075.10 / $19,070.59
| Facility | | $2,310.00 | $10,075.10 | $19,070.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,786.00 / $16,786.00 / $16,786.00
| Facility | | $16,786.00 | $16,786.00 | $16,786.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,792.00 / $9,900.00 / $18,068.13
| Facility | | $5,792.00 | $9,900.00 | $18,068.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $14,308.65 / $19,677.98
| Facility | | $5,616.00 | $14,308.65 | $19,677.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $16,081.19 / $22,858.42
| Facility | | $5,616.00 | $16,081.19 | $22,858.42 |