- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $16,299.80
| Facility | | $789.00 | $5,100.00 | $16,299.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,347.26 / $11,581.80 / $17,196.72
| Facility | | $8,347.26 | $11,581.80 | $17,196.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $13,029.88 / $19,787.00
| Facility | | $2,089.36 | $13,029.88 | $19,787.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,746.91 / $16,205.65 / $21,654.43
| Facility | | $10,746.91 | $16,205.65 | $21,654.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,688.45 / $17,708.80 / $25,980.00
| Facility | | $11,688.45 | $17,708.80 | $25,980.00 |