- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $6,085.00 / $10,594.80
| Facility | | $970.00 | $6,085.00 | $10,594.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,138.62 / $7,666.20 / $14,755.71
| Facility | | $5,138.62 | $7,666.20 | $14,755.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.36 / $8,555.04 / $13,757.04
| Facility | | $2,089.36 | $8,555.04 | $13,757.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,985.44 / $10,664.00 / $14,973.00
| Facility | | $6,985.44 | $10,664.00 | $14,973.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,472.88 / $11,510.64 / $17,462.88
| Facility | | $7,472.88 | $11,510.64 | $17,462.88 |