- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $21,792.90
| Facility | | $789.00 | $5,100.00 | $21,792.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,549.02 / $16,139.42 / $20,320.71
| Facility | | $15,549.02 | $16,139.42 | $20,320.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $17,213.66 / $26,221.11
| Facility | | $2,089.36 | $17,213.66 | $26,221.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,368.66 / $21,667.03 / $28,952.07
| Facility | | $14,368.66 | $21,667.03 | $28,952.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,627.51 / $23,676.75 / $34,735.37
| Facility | | $15,627.51 | $23,676.75 | $34,735.37 |