- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,757.13 / $6,564.08 / $10,986.00
| Facility | | $4,757.13 | $6,564.08 | $10,986.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,405.43 / $10,617.78 / $11,602.95
| Facility | | $8,405.43 | $10,617.78 | $11,602.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $7,541.78 / $11,400.13
| Facility | | $2,423.00 | $7,541.78 | $11,400.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,868.88 / $7,384.88 / $12,384.40
| Facility | | $4,868.88 | $7,384.88 | $12,384.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $5,960.00 / $13,252.76
| Facility | | $2,600.00 | $5,960.00 | $13,252.76 |