- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $16,104.10
| Facility | | $789.00 | $5,100.00 | $16,104.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,654.04 / $11,760.42 / $20,150.98
| Facility | | $11,654.04 | $11,760.42 | $20,150.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $12,873.43 / $19,624.78
| Facility | | $2,089.36 | $12,873.43 | $19,624.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,617.87 / $16,143.28 / $21,650.52
| Facility | | $10,617.87 | $16,143.28 | $21,650.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,548.11 / $17,496.16 / $25,668.06
| Facility | | $11,548.11 | $17,496.16 | $25,668.06 |