- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.60 / $8,376.48 / $11,766.70
| Facility | | $6,165.60 | $8,376.48 | $11,766.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,004.08 / $7,819.22 / $12,389.66
| Facility | | $5,004.08 | $7,819.22 | $12,389.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,378.69 / $7,425.60 / $13,440.00
| Facility | | $5,378.69 | $7,425.60 | $13,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.17 / $83.05 / $133.80
| Facility | | $57.17 | $83.05 | $133.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,924.35 / $8,199.07 / $13,493.76
| Facility | | $5,924.35 | $8,199.07 | $13,493.76 |