- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $11,858.80
| Facility | | $789.00 | $5,100.00 | $11,858.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.46 / $8,811.71 / $12,615.20
| Facility | | $5,906.46 | $8,811.71 | $12,615.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $9,575.70 / $14,782.62
| Facility | | $2,089.36 | $9,575.70 | $14,782.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,818.84 / $11,903.14 / $16,118.00
| Facility | | $7,818.84 | $11,903.14 | $16,118.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,503.86 / $12,883.92 / $18,901.58
| Facility | | $8,503.86 | $12,883.92 | $18,901.58 |