- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $14,791.08
| Facility | | $7,079.46 | $9,772.37 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,709.64 / $13,489.63
| Facility | | $5,495.41 | $8,709.64 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,709.64 / $15,135.61
| Facility | | $6,025.60 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $100.00 / $151.36
| Facility | | $67.61 | $100.00 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,549.93 / $14,125.38
| Facility | | $6,456.54 | $9,549.93 | $14,125.38 |