- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,500.49 / $8,831.45 / $12,687.00
| Facility | | $6,500.49 | $8,831.45 | $12,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,192.47 / $8,249.27 / $13,071.83
| Facility | | $5,192.47 | $8,249.27 | $13,071.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,670.83 / $7,828.93 / $14,170.00
| Facility | | $5,670.83 | $7,828.93 | $14,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.28 / $87.56 / $141.06
| Facility | | $60.28 | $87.56 | $141.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,246.14 / $8,644.41 / $14,226.68
| Facility | | $6,246.14 | $8,644.41 | $14,226.68 |