- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,766.00 / $18,625.00 / $29,988.60
| Facility | | $5,766.00 | $18,625.00 | $29,988.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,007.50 / $21,007.50 / $21,007.50
| Facility | | $21,007.50 | $21,007.50 | $21,007.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $17,694.88 / $25,614.52
| Facility | | $1,474.01 | $17,694.88 | $25,614.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,482.11 / $19,473.65 / $27,586.76
| Facility | | $13,482.11 | $19,473.65 | $27,586.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $12,715.55 / $33,733.15
| Facility | | $800.00 | $12,715.55 | $33,733.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $12,600.96 / $29,446.63
| Facility | | $755.00 | $12,600.96 | $29,446.63 |