- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $20,539.20
| Facility | | $789.00 | $5,100.00 | $20,539.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,597.81 / $22,746.94 / $27,674.56
| Facility | | $14,597.81 | $22,746.94 | $27,674.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $16,009.83 / $24,712.64
| Facility | | $2,089.36 | $16,009.83 | $24,712.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,542.05 / $20,420.55 / $27,286.49
| Facility | | $13,542.05 | $20,420.55 | $27,286.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,728.48 / $22,314.65 / $33,135.00
| Facility | | $14,728.48 | $22,314.65 | $33,135.00 |