- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,882.16 / $11,958.70 / $14,728.20
| Facility | | $9,882.16 | $11,958.70 | $14,728.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,672.45 / $10,562.70 / $10,745.68
| Facility | | $9,672.45 | $10,562.70 | $10,745.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,437.04 / $12,200.30 / $19,117.72
| Facility | | $9,437.04 | $12,200.30 | $19,117.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.00 / $5,392.50 / $8,766.00
| Facility | | $3,390.00 | $5,392.50 | $8,766.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,568.08 / $15,416.92 / $20,346.18
| Facility | | $11,568.08 | $15,416.92 | $20,346.18 |