- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,862.94 / $11,935.50 / $14,699.50
| Facility | | $9,862.94 | $11,935.50 | $14,699.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,653.62 / $10,542.15 / $10,724.78
| Facility | | $9,653.62 | $10,542.15 | $10,724.78 |
- 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
- $9,418.68 / $12,176.57 / $19,080.52
| Facility | | $9,418.68 | $12,176.57 | $19,080.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,545.58 / $15,386.92 / $20,306.59
| Facility | | $11,545.58 | $15,386.92 | $20,306.59 |