- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,650.00 / $18,128.00 / $27,706.70
| Facility | | $7,650.00 | $18,128.00 | $27,706.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,582.36 / $16,705.93 / $23,155.27
| Facility | | $15,582.36 | $16,705.93 | $23,155.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,314.73 / $18,689.75 / $27,414.62
| Facility | | $12,314.73 | $18,689.75 | $27,414.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,202.60 / $18,144.50 / $32,990.00
| Facility | | $13,202.60 | $18,144.50 | $32,990.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.34 / $208.10 / $3,100.00
| Facility | | $140.34 | $208.10 | $3,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,770.00 / $12,504.00 / $28,712.85
| Facility | | $5,770.00 | $12,504.00 | $28,712.85 |