- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.94 / $1,665.94 / $10,647.00
| Facility | | $1,665.94 | $1,665.94 | $10,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,077.00 / $11,939.03 / $22,972.08
| Facility | | $7,077.00 | $11,939.03 | $22,972.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,125.41 / $5,850.34 / $14,073.79
| Facility | | $4,125.41 | $5,850.34 | $14,073.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,353.66 / $5,348.62 / $11,081.73
| Facility | | $3,353.66 | $5,348.62 | $11,081.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.76 / $3,410.52 / $10,533.00
| Facility | | $2,185.76 | $3,410.52 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |