- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,564.31 / $1,564.31 / $10,647.00
| Facility | | $1,564.31 | $1,564.31 | $10,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,622.02 / $11,518.20 / $22,972.08
| Facility | | $6,622.02 | $11,518.20 | $22,972.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,875.26 / $5,495.60 / $13,220.40
| Facility | | $3,875.26 | $5,495.60 | $13,220.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,150.30 / $5,024.29 / $10,409.76
| Facility | | $3,150.30 | $5,024.29 | $10,409.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.09 / $3,187.42 / $10,878.00
| Facility | | $2,075.09 | $3,187.42 | $10,878.00 |
- 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 |