- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $5,100.00 / $17,456.40
| Facility | | $789.00 | $5,100.00 | $17,456.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,696.52 / $12,696.52 / $12,696.52
| Facility | | $12,696.52 | $12,696.52 | $12,696.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $13,954.45 / $21,003.44
| Facility | | $2,089.36 | $13,954.45 | $21,003.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,509.48 / $17,355.57 / $23,190.98
| Facility | | $11,509.48 | $17,355.57 | $23,190.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,517.84 / $18,965.38 / $27,823.48
| Facility | | $12,517.84 | $18,965.38 | $27,823.48 |