- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,321.58 / $8,870.87 / $13,005.00
| Facility | | $6,321.58 | $8,870.87 | $13,005.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,979.15 / $8,979.15 / $8,979.15
| Facility | | $8,979.15 | $8,979.15 | $8,979.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,145.45 / $8,017.03 / $12,915.30
| Facility | | $5,145.45 | $8,017.03 | $12,915.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,514.76 / $7,613.45 / $13,780.00
| Facility | | $5,514.76 | $7,613.45 | $13,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.62 / $85.15 / $137.18
| Facility | | $58.62 | $85.15 | $137.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,074.22 / $8,406.49 / $13,835.12
| Facility | | $6,074.22 | $8,406.49 | $13,835.12 |