- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $6,003.00 / $11,696.50
| Facility | | $850.00 | $6,003.00 | $11,696.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,714.48 / $13,088.73 / $22,375.10
| Facility | | $11,714.48 | $13,088.73 | $22,375.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.00 / $6,670.00 / $12,455.21
| Facility | | $2,178.00 | $6,670.00 | $12,455.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,396.66 / $15,677.51 / $21,199.46
| Facility | | $10,396.66 | $15,677.51 | $21,199.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,579.00 / $10,197.35 / $22,313.93
| Facility | | $4,579.00 | $10,197.35 | $22,313.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,464.11 / $34,094.93 / $34,094.93
| Facility | | $23,464.11 | $34,094.93 | $34,094.93 |