- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.88 / $1,679.61 / $10,561.00
| Facility | | $1,091.88 | $1,679.61 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,855.05 / $6,855.05 / $6,955.07
| Facility | | $6,855.05 | $6,855.05 | $6,955.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $11,384.53
| Facility | | $748.70 | $748.70 | $11,384.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.88 / $1,356.98 / $2,288.00
| Facility | | $1,091.88 | $1,356.98 | $2,288.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,244.90 / $33,500.00 / $38,302.10
| Facility | | $5,244.90 | $33,500.00 | $38,302.10 |