- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.00 / $7,854.00 / $14,220.00
| Facility | | $2,060.00 | $7,854.00 | $14,220.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,338.60 / $10,501.84 / $18,842.68
| Facility | | $6,338.60 | $10,501.84 | $18,842.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,742.00 / $12,594.12
| Facility | | $687.00 | $2,742.00 | $12,594.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,025.46 / $11,014.70 / $24,753.38
| Facility | | $7,025.46 | $11,014.70 | $24,753.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,941.38 / $27,165.85 / $27,165.85
| Facility | | $15,941.38 | $27,165.85 | $27,165.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,028.80 / $16,018.80 / $42,234.00
| Facility | | $4,028.80 | $16,018.80 | $42,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,960.28 / $10,812.60 / $27,614.33
| Facility | | $7,960.28 | $10,812.60 | $27,614.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.00 / $8,892.21 / $14,742.00
| Facility | | $3,090.00 | $8,892.21 | $14,742.00 |