- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.42 / $1,490.42 / $10,270.00
| Facility | | $1,490.42 | $1,490.42 | $10,270.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,253.86 / $19,345.89 / $47,996.64
| Facility | | $3,253.86 | $19,345.89 | $47,996.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,464.13 / $4,915.10 / $11,823.94
| Facility | | $3,464.13 | $4,915.10 | $11,823.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,817.54 / $4,493.58 / $9,310.19
| Facility | | $2,817.54 | $4,493.58 | $9,310.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.72 / $2,635.84 / $10,831.00
| Facility | | $1,594.72 | $2,635.84 | $10,831.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |