- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,766.49 / $8,091.94 / $12,711.40
| Facility | | $5,766.49 | $8,091.94 | $12,711.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,689.89 / $7,307.25 / $11,771.86
| Facility | | $4,689.89 | $7,307.25 | $11,771.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,030.51 / $7,000.00 / $12,570.00
| Facility | | $5,030.51 | $7,000.00 | $12,570.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.47 / $77.68 / $125.13
| Facility | | $53.47 | $77.68 | $125.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,540.86 / $7,668.33 / $12,620.28
| Facility | | $5,540.86 | $7,668.33 | $12,620.28 |