- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,320.00 / $6,300.00 / $10,226.90
| Facility | | $4,320.00 | $6,300.00 | $10,226.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,424.51 / $8,244.85 / $9,545.37
| Facility | | $3,424.51 | $8,244.85 | $9,545.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,560.35 / $13,591.46 / $17,424.95
| Facility | | $9,560.35 | $13,591.46 | $17,424.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,072.70 / $9,807.58 / $12,404.82
| Facility | | $5,072.70 | $9,807.58 | $12,404.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,507.20 / $6,775.20 / $10,833.80
| Facility | | $4,507.20 | $6,775.20 | $10,833.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,271.12 / $9,013.68 / $13,694.40
| Facility | | $5,271.12 | $9,013.68 | $13,694.40 |