- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $7,142.72 / $33,573.69
| Facility | | $789.00 | $7,142.72 | $33,573.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $25,761.55 / $40,395.73
| Facility | | $2,089.36 | $25,761.55 | $40,395.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,982.25 / $33,379.81 / $44,603.00
| Facility | | $19,982.25 | $33,379.81 | $44,603.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,624.75 / $6,624.75 / $47,504.26
| Facility | | $6,624.75 | $6,624.75 | $47,504.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,680.73 / $36,505.60 / $53,512.65
| Facility | | $23,680.73 | $36,505.60 | $53,512.65 |