- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $4,550.00 / $12,379.70
| Facility | | $789.00 | $4,550.00 | $12,379.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,814.46 / $9,814.46 / $10,045.36
| Facility | | $9,814.46 | $9,814.46 | $10,045.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $9,953.42 / $15,431.97
| Facility | | $2,089.36 | $9,953.42 | $15,431.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,162.29 / $12,308.22 / $16,446.57
| Facility | | $8,162.29 | $12,308.22 | $16,446.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,731.85 / $13,049.40 / $19,731.84
| Facility | | $8,731.85 | $13,049.40 | $19,731.84 |