- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $14,717.90
| Facility | | $789.00 | $5,100.00 | $14,717.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,808.43 / $13,808.43 / $13,808.43
| Facility | | $13,808.43 | $13,808.43 | $13,808.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $11,765.35 / $18,162.63
| Facility | | $2,089.36 | $11,765.35 | $18,162.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,703.94 / $14,753.75 / $20,004.00
| Facility | | $9,703.94 | $14,753.75 | $20,004.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,554.11 / $15,990.20 / $23,458.69
| Facility | | $10,554.11 | $15,990.20 | $23,458.69 |