- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,306.05 / $9,925.87 / $14,551.00
| Facility | | $7,306.05 | $9,925.87 | $14,551.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.53 / $9,228.06 / $14,625.00
| Facility | | $5,779.53 | $9,228.06 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,373.59 / $8,940.06 / $15,926.00
| Facility | | $6,373.59 | $8,940.06 | $15,926.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.75 / $100.00 / $158.03
| Facility | | $67.75 | $100.00 | $158.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,020.18 / $9,715.66 / $15,989.70
| Facility | | $7,020.18 | $9,715.66 | $15,989.70 |