- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,801.42 / $11,861.00 / $14,607.80
| Facility | | $9,801.42 | $11,861.00 | $14,607.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,593.42 / $10,476.39 / $10,657.88
| Facility | | $9,593.42 | $10,476.39 | $10,657.88 |
- 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
- $9,359.93 / $12,100.61 / $18,961.50
| Facility | | $9,359.93 | $12,100.61 | $18,961.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,473.56 / $15,290.94 / $20,179.91
| Facility | | $11,473.56 | $15,290.94 | $20,179.91 |