- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,909.08 / $11,991.30 / $14,768.30
| Facility | | $9,909.08 | $11,991.30 | $14,768.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,698.79 / $10,591.47 / $10,774.95
| Facility | | $9,698.79 | $10,591.47 | $10,774.95 |
- 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
- $9,462.74 / $12,233.53 / $19,169.79
| Facility | | $9,462.74 | $12,233.53 | $19,169.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,599.59 / $15,458.91 / $20,401.59
| Facility | | $11,599.59 | $15,458.91 | $20,401.59 |