- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,783.92 / $7,857.94 / $11,898.00
| Facility | | $5,783.92 | $7,857.94 | $11,898.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,704.84 / $7,330.52 / $11,809.35
| Facility | | $4,704.84 | $7,330.52 | $11,809.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,045.72 / $6,965.92 / $12,608.00
| Facility | | $5,045.72 | $6,965.92 | $12,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.63 / $77.91 / $125.51
| Facility | | $53.63 | $77.91 | $125.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,557.61 / $7,691.51 / $12,658.43
| Facility | | $5,557.61 | $7,691.51 | $12,658.43 |