- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,557.00 / $8,166.84 / $12,608.90
| Facility | | $5,557.00 | $8,166.84 | $12,608.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,555.46 / $13,584.53 / $17,416.07
| Facility | | $9,555.46 | $13,584.53 | $17,416.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.20 / $11,649.29 / $15,294.10
| Facility | | $174.20 | $11,649.29 | $15,294.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,557.00 / $8,353.26 / $13,357.20
| Facility | | $5,557.00 | $8,353.26 | $13,357.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,498.85 / $11,113.12 / $16,884.05
| Facility | | $6,498.85 | $11,113.12 | $16,884.05 |