- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,859.31 / $8,810.70 / $24,560.00
| Facility | | $6,859.31 | $8,810.70 | $24,560.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,362.77 / $9,362.77 / $9,362.77
| Facility | | $9,362.77 | $9,362.77 | $9,362.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.89 / $8,045.93 / $13,488.02
| Facility | | $5,255.89 | $8,045.93 | $13,488.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,586.75 / $9,387.98 / $13,760.00
| Facility | | $7,586.75 | $9,387.98 | $13,760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,716.25 / $9,424.95 / $23,502.27
| Facility | | $4,716.25 | $9,424.95 | $23,502.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,716.25 / $9,224.23 / $12,647.10
| Facility | | $4,716.25 | $9,224.23 | $12,647.10 |