- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $15,488.17
| Facility | | $7,413.10 | $10,232.93 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,120.11 / $14,125.38
| Facility | | $5,754.40 | $9,120.11 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,709.64 / $15,848.93
| Facility | | $6,025.60 | $8,709.64 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $100.00 / $154.88
| Facility | | $67.61 | $100.00 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,000.00 / $14,791.08
| Facility | | $6,760.83 | $10,000.00 | $14,791.08 |