- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,805.51 / $10,655.80 / $13,123.50
| Facility | | $8,805.51 | $10,655.80 | $13,123.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,618.64 / $9,411.90 / $9,574.95
| Facility | | $8,618.64 | $9,411.90 | $9,574.95 |
- 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
- $8,408.87 / $10,871.09 / $17,034.84
| Facility | | $8,408.87 | $10,871.09 | $17,034.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.00 / $5,392.50 / $8,535.75
| Facility | | $3,390.00 | $5,392.50 | $8,535.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,307.75 / $13,737.25 / $18,129.47
| Facility | | $10,307.75 | $13,737.25 | $18,129.47 |