- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,785.62 / $8,655.83 / $13,937.00
| Facility | | $3,785.62 | $8,655.83 | $13,937.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,801.55 / $7,801.55 / $7,801.55
| Facility | | $7,801.55 | $7,801.55 | $7,801.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $5,490.79 / $12,044.51
| Facility | | $1,474.01 | $5,490.79 | $12,044.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,265.71 / $9,415.12 / $13,910.11
| Facility | | $6,265.71 | $9,415.12 | $13,910.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,476.92 / $7,590.68 / $15,941.36
| Facility | | $5,476.92 | $7,590.68 | $15,941.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,476.92 / $7,590.68 / $13,685.10
| Facility | | $5,476.92 | $7,590.68 | $13,685.10 |