- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $22,512.50
| Facility | | $789.00 | $5,100.00 | $22,512.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,057.13 / $25,968.23 / $41,310.03
| Facility | | $17,057.13 | $25,968.23 | $41,310.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $17,547.95 / $27,086.88
| Facility | | $2,089.36 | $17,547.95 | $27,086.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,843.09 / $22,382.44 / $29,908.02
| Facility | | $14,843.09 | $22,382.44 | $29,908.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,143.50 / $24,458.51 / $35,882.26
| Facility | | $16,143.50 | $24,458.51 | $35,882.26 |