- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,487.00 / $9,121.40 / $26,792.20
| Facility | | $3,487.00 | $9,121.40 | $26,792.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,488.00 / $3,488.00 / $3,488.00
| Facility | | $3,488.00 | $3,488.00 | $3,488.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,295.77 / $13,437.68 / $21,899.54
| Facility | | $9,295.77 | $13,437.68 | $21,899.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.02 / $13,239.63 / $19,472.50
| Facility | | $7,621.02 | $13,239.63 | $19,472.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,213.50 / $21,360.19 / $31,037.80
| Facility | | $18,213.50 | $21,360.19 | $31,037.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.00 / $7,677.43 / $17,827.30
| Facility | | $2,820.00 | $7,677.43 | $17,827.30 |