- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,991.20 / $6,780.96 / $10,504.00
| Facility | | $4,991.20 | $6,780.96 | $10,504.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,276.73 / $5,588.54 / $7,463.23
| Facility | | $5,276.73 | $5,588.54 | $7,463.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.59 / $6,330.46 / $10,464.92
| Facility | | $4,062.59 | $6,330.46 | $10,464.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,354.18 / $6,107.49 / $10,880.00
| Facility | | $4,354.18 | $6,107.49 | $10,880.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.28 / $67.23 / $115.53
| Facility | | $46.28 | $67.23 | $115.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,795.89 / $6,637.34 / $10,923.52
| Facility | | $4,795.89 | $6,637.34 | $10,923.52 |