- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $6,085.00 / $14,814.50
| Facility | | $789.00 | $6,085.00 | $14,814.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,394.60 / $12,256.58 / $33,909.86
| Facility | | $7,394.60 | $12,256.58 | $33,909.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $12,249.82 / $18,992.34
| Facility | | $2,200.00 | $12,249.82 | $18,992.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,045.45 / $15,272.98 / $20,708.00
| Facility | | $10,045.45 | $15,272.98 | $20,708.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,466.67 / $13,778.50 / $24,089.62
| Facility | | $9,466.67 | $13,778.50 | $24,089.62 |