- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,834.10 / $11,900.60 / $14,656.50
| Facility | | $9,834.10 | $11,900.60 | $14,656.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,625.41 / $10,511.33 / $10,693.42
| Facility | | $9,625.41 | $10,511.33 | $10,693.42 |
- 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
- $9,391.14 / $12,140.96 / $19,024.73
| Facility | | $9,391.14 | $12,140.96 | $19,024.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,511.82 / $15,341.93 / $20,247.22
| Facility | | $11,511.82 | $15,341.93 | $20,247.22 |