- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,923.46 / $9,715.46 / $15,565.00
| Facility | | $6,923.46 | $9,715.46 | $15,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,638.34 / $8,752.75 / $14,152.47
| Facility | | $5,638.34 | $8,752.75 | $14,152.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,039.82 / $8,338.33 / $15,092.00
| Facility | | $6,039.82 | $8,338.33 | $15,092.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.20 / $93.26 / $150.00
| Facility | | $64.20 | $93.26 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,652.55 / $9,206.87 / $15,152.37
| Facility | | $6,652.55 | $9,206.87 | $15,152.37 |