- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,088.53 / $8,271.77 / $12,142.00
| Facility | | $6,088.53 | $8,271.77 | $12,142.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,171.61 / $6,171.61 / $6,171.61
| Facility | | $6,171.61 | $6,171.61 | $6,171.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,958.75 / $7,726.13 / $12,446.68
| Facility | | $4,958.75 | $7,726.13 | $12,446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,311.45 / $7,332.78 / $13,272.00
| Facility | | $5,311.45 | $7,332.78 | $13,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.46 / $82.01 / $132.12
| Facility | | $56.46 | $82.01 | $132.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,850.30 / $8,096.58 / $13,325.09
| Facility | | $5,850.30 | $8,096.58 | $13,325.09 |