- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,494.91 / $7,710.84 / $12,112.80
| Facility | | $5,494.91 | $7,710.84 | $12,112.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,386.87 / $6,970.17 / $11,043.76
| Facility | | $4,386.87 | $6,970.17 | $11,043.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,793.60 / $6,617.85 / $11,978.00
| Facility | | $4,793.60 | $6,617.85 | $11,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.95 / $75.56 / $120.54
| Facility | | $50.95 | $75.56 | $120.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.90 / $7,471.28 / $12,954.21
| Facility | | $5,279.90 | $7,471.28 | $12,954.21 |