- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,890.35 / $8,265.75 / $13,016.00
| Facility | | $5,890.35 | $8,265.75 | $13,016.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,794.45 / $7,470.15 / $12,034.29
| Facility | | $4,794.45 | $7,470.15 | $12,034.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,138.57 / $7,207.73 / $12,840.00
| Facility | | $5,138.57 | $7,207.73 | $12,840.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.62 / $79.34 / $127.82
| Facility | | $54.62 | $79.34 | $127.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,606.08 / $7,822.77 / $12,417.56
| Facility | | $5,606.08 | $7,822.77 | $12,417.56 |