- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,049.15 / $9,576.86 / $14,297.00
| Facility | | $7,049.15 | $9,576.86 | $14,297.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,671.56 / $8,903.45 / $14,242.37
| Facility | | $5,671.56 | $8,903.45 | $14,242.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,149.47 / $8,489.71 / $15,366.00
| Facility | | $6,149.47 | $8,489.71 | $15,366.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.37 / $94.95 / $152.47
| Facility | | $65.37 | $94.95 | $152.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,773.33 / $9,374.03 / $15,427.46
| Facility | | $6,773.33 | $9,374.03 | $15,427.46 |