- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,954.57 / $8,089.78 / $12,167.00
| Facility | | $5,954.57 | $8,089.78 | $12,167.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,846.72 / $7,551.60 / $12,165.50
| Facility | | $4,846.72 | $7,551.60 | $12,165.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,194.60 / $7,171.45 / $12,980.00
| Facility | | $5,194.60 | $7,171.45 | $12,980.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.22 / $80.20 / $129.22
| Facility | | $55.22 | $80.20 | $129.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,721.58 / $7,918.45 / $13,031.92
| Facility | | $5,721.58 | $7,918.45 | $13,031.92 |