- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $2,047.40 / $12,615.00
| Facility | | $1,322.40 | $2,047.40 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,683.54 / $5,683.54 / $8,121.06
| Facility | | $5,683.54 | $5,683.54 | $8,121.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $1,872.01 / $3,000.00
| Facility | | $1,322.40 | $1,872.01 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,870.00 / $25,381.00
| Facility | | $4,015.00 | $15,870.00 | $25,381.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,077.03 / $17,132.00 / $18,000.00
| Facility | | $14,077.03 | $17,132.00 | $18,000.00 |