- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,250.26 / $2,250.26 / $11,316.00
| Facility | | $2,250.26 | $2,250.26 | $11,316.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,428.23 / $13,140.86 / $23,114.40
| Facility | | $7,428.23 | $13,140.86 | $23,114.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,974.41 / $7,054.33 / $16,970.15
| Facility | | $4,974.41 | $7,054.33 | $16,970.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,043.84 / $6,449.35 / $13,362.33
| Facility | | $4,043.84 | $6,449.35 | $13,362.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.46 / $3,802.94 / $6,138.40
| Facility | | $2,781.46 | $3,802.94 | $6,138.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |