- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,370.27 / $8,174.13 / $13,571.00
| Facility | | $6,370.27 | $8,174.13 | $13,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,854.59 / $7,431.60 / $12,560.04
| Facility | | $4,854.59 | $7,431.60 | $12,560.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,045.84 / $8,935.20 / $13,236.00
| Facility | | $7,045.84 | $8,935.20 | $13,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,380.00 / $8,787.00 / $21,707.80
| Facility | | $4,380.00 | $8,787.00 | $21,707.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,380.00 / $8,566.58 / $11,745.41
| Facility | | $4,380.00 | $8,566.58 | $11,745.41 |