- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.22 / $1,404.22 / $7,397.00
| Facility | | $1,404.22 | $1,404.22 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,991.35 / $11,098.97 / $21,650.55
| Facility | | $5,991.35 | $11,098.97 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,476.02 / $4,929.43 / $11,858.42
| Facility | | $3,476.02 | $4,929.43 | $11,858.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,825.76 / $4,506.68 / $9,337.34
| Facility | | $2,825.76 | $4,506.68 | $9,337.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.93 / $2,863.18 / $10,533.00
| Facility | | $1,836.93 | $2,863.18 | $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 |