- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $15,127.00
| Facility | | $789.00 | $5,100.00 | $15,127.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,400.43 / $11,400.43 / $11,400.43
| Facility | | $11,400.43 | $11,400.43 | $11,400.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $11,948.44 / $18,434.09
| Facility | | $2,089.36 | $11,948.44 | $18,434.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,973.66 / $15,163.82 / $20,336.91
| Facility | | $9,973.66 | $15,163.82 | $20,336.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,624.75 / $6,624.75 / $23,832.13
| Facility | | $6,624.75 | $6,624.75 | $23,832.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,847.46 / $16,434.64 / $24,110.71
| Facility | | $10,847.46 | $16,434.64 | $24,110.71 |