- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.51 / $9,006.31 / $13,190.00
| Facility | | $6,085.51 | $9,006.31 | $13,190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,013.16 / $12,813.55 / $16,427.63
| Facility | | $9,013.16 | $12,813.55 | $16,427.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,710.82 / $7,270.10 / $15,069.54
| Facility | | $3,710.82 | $7,270.10 | $15,069.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.51 / $11,006.60 / $13,801.40
| Facility | | $6,085.51 | $11,006.60 | $13,801.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $6,843.00 / $14,407.23
| Facility | | $3,800.00 | $6,843.00 | $14,407.23 |