- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $15,097.60
| Facility | | $789.00 | $5,100.00 | $15,097.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,025.40 / $11,025.40 / $11,025.40
| Facility | | $11,025.40 | $11,025.40 | $11,025.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $11,925.20 / $18,399.52
| Facility | | $2,089.36 | $11,925.20 | $18,399.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,954.25 / $15,134.32 / $20,297.36
| Facility | | $9,954.25 | $15,134.32 | $20,297.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,401.56 / $13,507.29 / $21,364.40
| Facility | | $9,401.56 | $13,507.29 | $21,364.40 |