- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,428.60 / $11,257.00 / $14,697.50
| Facility | | $5,428.60 | $11,257.00 | $14,697.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.00 / $9,750.00 / $27,527.60
| Facility | | $2,503.00 | $9,750.00 | $27,527.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,360.56 / $10,517.32 / $15,891.80
| Facility | | $6,360.56 | $10,517.32 | $15,891.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,935.68 / $14,935.68 / $14,935.68
| Facility | | $14,935.68 | $14,935.68 | $14,935.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,164.32 / $10,595.25 / $16,361.56
| Facility | | $9,164.32 | $10,595.25 | $16,361.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.00 / $9,750.00 / $27,527.60
| Facility | | $2,503.00 | $9,750.00 | $27,527.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.00 / $7,994.61 / $21,513.06
| Facility | | $2,503.00 | $7,994.61 | $21,513.06 |