- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,507.75 / $7,728.86 / $12,340.00
| Facility | | $5,507.75 | $7,728.86 | $12,340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,480.80 / $6,982.13 / $11,247.00
| Facility | | $4,480.80 | $6,982.13 | $11,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.80 / $6,633.32 / $12,006.00
| Facility | | $4,804.80 | $6,633.32 | $12,006.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.07 / $74.19 / $120.82
| Facility | | $51.07 | $74.19 | $120.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,292.24 / $7,324.26 / $12,054.02
| Facility | | $5,292.24 | $7,324.26 | $12,054.02 |