- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $30,801.40
| Facility | | $789.00 | $5,100.00 | $30,801.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,513.01 / $22,513.01 / $22,513.01
| Facility | | $22,513.01 | $22,513.01 | $22,513.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $23,699.21 / $37,060.11
| Facility | | $2,089.36 | $23,699.21 | $37,060.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,332.25 / $30,623.52 / $40,919.97
| Facility | | $18,332.25 | $30,623.52 | $40,919.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,387.25 / $27,211.60 / $43,586.70
| Facility | | $17,387.25 | $27,211.60 | $43,586.70 |