- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.00 / $10,776.10 / $21,904.60
| Facility | | $1,561.00 | $10,776.10 | $21,904.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,341.26 / $2,341.26 / $2,341.26
| Facility | | $2,341.26 | $2,341.26 | $2,341.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,070.64 / $12,623.76 / $14,432.22
| Facility | | $10,070.64 | $12,623.76 | $14,432.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,616.89 / $11,815.88 / $15,367.06
| Facility | | $6,616.89 | $11,815.88 | $15,367.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,809.51 / $2,809.51 / $2,809.51
| Facility | | $2,809.51 | $2,809.51 | $2,809.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $3,800.00 / $13,318.97
| Facility | | $1,286.00 | $3,800.00 | $13,318.97 |