- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.13 / $6,216.36 / $10,404.00
| Facility | | $4,505.13 | $6,216.36 | $10,404.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,473.08 / $9,473.08 / $9,473.08
| Facility | | $9,473.08 | $9,473.08 | $9,473.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $6,857.67 / $10,339.65
| Facility | | $2,423.00 | $6,857.67 | $10,339.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,610.96 / $6,993.68 / $11,728.36
| Facility | | $4,610.96 | $6,993.68 | $11,728.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $5,644.28 / $12,550.72
| Facility | | $2,600.00 | $5,644.28 | $12,550.72 |