- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $7,462.46 / $15,448.70
| Facility | | $2,310.00 | $7,462.46 | $15,448.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,051.90 / $10,438.56 / $17,090.57
| Facility | | $9,051.90 | $10,438.56 | $17,090.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,898.00 / $11,333.30 / $13,349.16
| Facility | | $2,898.00 | $11,333.30 | $13,349.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $10,079.29 / $16,101.92
| Facility | | $5,616.00 | $10,079.29 | $16,101.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,616.00 / $11,327.91 / $17,147.00
| Facility | | $5,616.00 | $11,327.91 | $17,147.00 |