- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $16,537.59 / $17,382.00
| Facility | | $3,822.00 | $16,537.59 | $17,382.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,750.00 / $33,681.30
| Facility | | $3,750.00 | $9,750.00 | $33,681.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,344.27 / $15,450.96 / $23,346.58
| Facility | | $9,344.27 | $15,450.96 | $23,346.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,394.00 / $9,637.00 / $22,682.00
| Facility | | $8,394.00 | $9,637.00 | $22,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,463.27 / $15,565.45 / $24,036.71
| Facility | | $13,463.27 | $15,565.45 | $24,036.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,750.00 / $33,681.30
| Facility | | $3,750.00 | $9,750.00 | $33,681.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,750.00 / $9,116.00 / $18,973.00
| Facility | | $3,750.00 | $9,116.00 | $18,973.00 |