- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,722.18 / $9,792.12 / $12,785.00
| Facility | | $4,722.18 | $9,792.12 | $12,785.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,942.20 / $23,945.50
| Facility | | $5,840.42 | $8,942.20 | $23,945.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,532.87 / $9,148.73 / $13,823.84
| Facility | | $5,532.87 | $9,148.73 | $13,823.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,992.13 / $12,992.13 / $12,992.13
| Facility | | $12,992.13 | $12,992.13 | $12,992.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,971.79 / $9,216.52 / $14,232.47
| Facility | | $7,971.79 | $9,216.52 | $14,232.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,942.20 / $23,945.50
| Facility | | $5,840.42 | $8,942.20 | $23,945.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,826.71 / $18,713.62
| Facility | | $5,840.42 | $8,826.71 | $18,713.62 |