- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $5,446.00 / $25,638.00
| Facility | | $800.00 | $5,446.00 | $25,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,072.95 / $12,072.95 / $12,072.95
| Facility | | $12,072.95 | $12,072.95 | $12,072.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $18,976.80 / $29,675.35
| Facility | | $2,089.36 | $18,976.80 | $29,675.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,261.52 / $24,723.82 / $33,522.00
| Facility | | $16,261.52 | $24,723.82 | $33,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,396.24 / $26,795.81 / $40,087.00
| Facility | | $17,396.24 | $26,795.81 | $40,087.00 |