- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,316.00 / $9,376.00 / $13,472.00
| Facility | | $4,316.00 | $9,376.00 | $13,472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,844.88 / $8,469.84 / $15,937.87
| Facility | | $5,844.88 | $8,469.84 | $15,937.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.56 / $8,981.45 / $14,760.62
| Facility | | $2,884.56 | $8,981.45 | $14,760.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,528.83 / $11,481.63 / $17,157.72
| Facility | | $7,528.83 | $11,481.63 | $17,157.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,401.00 / $14,554.63
| Facility | | $3,300.00 | $9,401.00 | $14,554.63 |