- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $6,085.00 / $22,983.40
| Facility | | $970.00 | $6,085.00 | $22,983.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,201.56 / $17,201.56 / $23,740.12
| Facility | | $17,201.56 | $17,201.56 | $23,740.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $18,153.96 / $28,362.54
| Facility | | $2,089.36 | $18,153.96 | $28,362.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,153.55 / $22,850.60 / $30,533.58
| Facility | | $15,153.55 | $22,850.60 | $30,533.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,624.75 / $6,624.75 / $33,913.93
| Facility | | $6,624.75 | $6,624.75 | $33,913.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,734.58 / $24,226.63 / $36,632.80
| Facility | | $15,734.58 | $24,226.63 | $36,632.80 |