- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,350.94 / $8,912.08 / $14,880.00
| Facility | | $6,350.94 | $8,912.08 | $14,880.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,167.85 / $8,051.93 / $12,971.54
| Facility | | $5,167.85 | $8,051.93 | $12,971.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,540.37 / $7,648.81 / $13,844.00
| Facility | | $5,540.37 | $7,648.81 | $13,844.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.89 / $87.33 / $137.82
| Facility | | $58.89 | $87.33 | $137.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,572.44 / $8,635.20 / $14,832.00
| Facility | | $6,572.44 | $8,635.20 | $14,832.00 |