- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,973.75 / $8,245.04 / $11,060.00
| Facility | | $3,973.75 | $8,245.04 | $11,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,036.15 / $8,982.34 / $11,913.21
| Facility | | $6,036.15 | $8,982.34 | $11,913.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $6,412.04 / $7,624.22
| Facility | | $2,651.00 | $6,412.04 | $7,624.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,008.28 / $8,513.90 / $13,400.62
| Facility | | $7,008.28 | $8,513.90 | $13,400.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,703.10 / $10,518.70
| Facility | | $1,350.00 | $5,703.10 | $10,518.70 |