- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,044.56 / $9,570.62 / $14,985.00
| Facility | | $7,044.56 | $9,570.62 | $14,985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,640.29 / $8,903.45 / $14,159.61
| Facility | | $5,640.29 | $8,903.45 | $14,159.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,145.47 / $8,620.09 / $15,356.00
| Facility | | $6,145.47 | $8,620.09 | $15,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.31 / $94.89 / $152.37
| Facility | | $65.31 | $94.89 | $152.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,768.92 / $9,367.93 / $15,417.42
| Facility | | $6,768.92 | $9,367.93 | $15,417.42 |