- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $26,943.20
| Facility | | $789.00 | $5,100.00 | $26,943.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,541.93 / $25,541.93 / $30,884.41
| Facility | | $25,541.93 | $25,541.93 | $30,884.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $20,730.58 / $32,417.86
| Facility | | $2,089.36 | $20,730.58 | $32,417.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,035.90 / $26,787.53 / $35,794.22
| Facility | | $16,035.90 | $26,787.53 | $35,794.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,320.71 / $29,272.20 / $42,944.27
| Facility | | $19,320.71 | $29,272.20 | $42,944.27 |