- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,759.15 / $7,824.28 / $11,999.00
| Facility | | $5,759.15 | $7,824.28 | $11,999.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.68 / $7,307.25 / $11,578.43
| Facility | | $4,637.68 | $7,307.25 | $11,578.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,024.10 / $7,047.19 / $12,554.00
| Facility | | $5,024.10 | $7,047.19 | $12,554.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.40 / $77.58 / $125.00
| Facility | | $53.40 | $77.58 | $125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,533.80 / $7,658.57 / $12,604.22
| Facility | | $5,533.80 | $7,658.57 | $12,604.22 |