- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,061.67 / $9,743.98 / $16,308.00
| Facility | | $7,061.67 | $9,743.98 | $16,308.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,833.82 / $12,833.82 / $12,833.82
| Facility | | $12,833.82 | $12,833.82 | $12,833.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $11,745.88 / $17,606.65
| Facility | | $2,423.00 | $11,745.88 | $17,606.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,227.56 / $10,962.40 / $18,383.88
| Facility | | $7,227.56 | $10,962.40 | $18,383.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $8,847.26 / $19,672.91
| Facility | | $2,600.00 | $8,847.26 | $19,672.91 |