- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.33 / $1,208.33 / $6,575.00
| Facility | | $1,208.33 | $1,208.33 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,793.02 / $31,774.48 / $66,228.75
| Facility | | $5,793.02 | $31,774.48 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,936.30 / $4,166.18 / $10,022.33
| Facility | | $2,936.30 | $4,166.18 | $10,022.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,669.37 / $3,808.90 / $7,891.60
| Facility | | $2,669.37 | $3,808.90 | $7,891.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.15 / $2,067.30 / $5,577.00
| Facility | | $1,309.15 | $2,067.30 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |