- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $25,842.50
| Facility | | $789.00 | $5,100.00 | $25,842.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,138.63 / $19,138.63 / $19,138.63
| Facility | | $19,138.63 | $19,138.63 | $19,138.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $19,829.25 / $31,093.52
| Facility | | $2,089.36 | $19,829.25 | $31,093.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,407.00 / $25,693.21 / $34,331.94
| Facility | | $15,407.00 | $25,693.21 | $34,331.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,531.41 / $28,076.37 / $41,189.91
| Facility | | $18,531.41 | $28,076.37 | $41,189.91 |