- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $4,479.00 / $24,744.70
| Facility | | $789.00 | $4,479.00 | $24,744.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,655.12 / $17,655.12 / $23,273.83
| Facility | | $17,655.12 | $17,655.12 | $23,273.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $19,287.95 / $29,772.73
| Facility | | $2,089.36 | $19,287.95 | $29,772.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,727.45 / $24,601.81 / $32,873.60
| Facility | | $14,727.45 | $24,601.81 | $32,873.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,744.24 / $26,883.74 / $39,440.25
| Facility | | $17,744.24 | $26,883.74 | $39,440.25 |