- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,530.00 / $6,606.25 / $10,724.00
| Facility | | $4,530.00 | $6,606.25 | $10,724.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,602.56 / $13,651.47 / $17,501.89
| Facility | | $9,602.56 | $13,651.47 | $17,501.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,319.28 / $10,284.34 / $13,007.83
| Facility | | $5,319.28 | $10,284.34 | $13,007.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.30 / $7,104.55 / $11,360.50
| Facility | | $4,726.30 | $7,104.55 | $11,360.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,527.36 / $9,026.03 / $14,194.76
| Facility | | $5,527.36 | $9,026.03 | $14,194.76 |