- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,409.73 / $10,066.70 / $14,790.00
| Facility | | $7,409.73 | $10,066.70 | $14,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,928.48 / $9,367.18 / $14,625.00
| Facility | | $5,928.48 | $9,367.18 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,428.50 / $8,616.28 / $16,152.00
| Facility | | $6,428.50 | $8,616.28 | $16,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.70 / $99.81 / $160.27
| Facility | | $68.70 | $99.81 | $160.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,119.80 / $9,853.53 / $16,216.61
| Facility | | $7,119.80 | $9,853.53 | $16,216.61 |