- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $21,141.00
| Facility | | $789.00 | $5,100.00 | $21,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,487.77 / $15,649.40 / $21,241.65
| Facility | | $12,487.77 | $15,649.40 | $21,241.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $16,698.75 / $25,436.77
| Facility | | $2,089.36 | $16,698.75 | $25,436.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,938.86 / $21,018.92 / $28,086.05
| Facility | | $13,938.86 | $21,018.92 | $28,086.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,160.06 / $21,997.31 / $31,555.68
| Facility | | $15,160.06 | $21,997.31 | $31,555.68 |