- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,608.75 / $8,978.54 / $13,324.00
| Facility | | $6,608.75 | $8,978.54 | $13,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,376.96 / $8,361.65 / $13,274.64
| Facility | | $5,376.96 | $8,361.65 | $13,274.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,733.59 / $7,684.88 / $14,406.00
| Facility | | $5,733.59 | $7,684.88 | $14,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.28 / $89.02 / $143.41
| Facility | | $61.28 | $89.02 | $143.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,350.16 / $8,788.37 / $14,463.62
| Facility | | $6,350.16 | $8,788.37 | $14,463.62 |