- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $8,165.00 / $12,604.50
| Facility | | $4,804.00 | $8,165.00 | $12,604.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,292.50 / $8,292.50 / $8,292.50
| Facility | | $8,292.50 | $8,292.50 | $8,292.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,556.00 / $8,472.40
| Facility | | $688.00 | $2,556.00 | $8,472.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,862.22 / $7,840.00 / $13,442.97
| Facility | | $4,862.22 | $7,840.00 | $13,442.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,773.00 / $17,633.70 / $17,633.70
| Facility | | $10,773.00 | $17,633.70 | $17,633.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.30 / $104.30 / $104.30
| Facility | | $104.30 | $104.30 | $104.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,962.30 / $6,950.00 / $13,442.97
| Facility | | $4,962.30 | $6,950.00 | $13,442.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $6,227.20 / $14,236.94
| Facility | | $2,800.00 | $6,227.20 | $14,236.94 |