- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $14,361.80
| Facility | | $789.00 | $5,100.00 | $14,361.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,955.60 / $11,955.60 / $18,509.40
| Facility | | $11,955.60 | $11,955.60 | $18,509.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $11,480.69 / $17,723.18
| Facility | | $2,089.36 | $11,480.69 | $17,723.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,469.15 / $14,396.78 / $19,483.00
| Facility | | $9,469.15 | $14,396.78 | $19,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,298.75 / $15,603.31 / $22,891.10
| Facility | | $10,298.75 | $15,603.31 | $22,891.10 |