- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $24,006.10
| Facility | | $789.00 | $5,100.00 | $24,006.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,849.73 / $16,849.73 / $29,345.51
| Facility | | $16,849.73 | $16,849.73 | $29,345.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $18,470.71 / $28,883.94
| Facility | | $2,089.36 | $18,470.71 | $28,883.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,827.84 / $23,867.38 / $31,892.24
| Facility | | $15,827.84 | $23,867.38 | $31,892.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,214.53 / $26,081.19 / $38,262.86
| Facility | | $17,214.53 | $26,081.19 | $38,262.86 |