- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.00 / $9,553.75 / $18,390.00
| Facility | | $2,045.00 | $9,553.75 | $18,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,787.74 / $16,284.24 / $21,939.49
| Facility | | $10,787.74 | $16,284.24 | $21,939.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,024.68 / $14,648.00 / $20,266.20
| Facility | | $10,024.68 | $14,648.00 | $20,266.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,106.24 / $13,654.80 / $28,634.56
| Facility | | $7,106.24 | $13,654.80 | $28,634.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,014.58 / $6,014.58 / $6,166.58
| Facility | | $6,014.58 | $6,014.58 | $6,166.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,024.68 / $15,271.10 / $20,271.20
| Facility | | $10,024.68 | $15,271.10 | $20,271.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.00 / $12,885.30 / $18,548.16
| Facility | | $4,346.00 | $12,885.30 | $18,548.16 |