- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,760.08 / $11,811.00 / $14,546.20
| Facility | | $9,760.08 | $11,811.00 | $14,546.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,552.95 / $10,432.20 / $10,612.93
| Facility | | $9,552.95 | $10,432.20 | $10,612.93 |
- 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
- $9,320.45 / $12,049.58 / $18,881.53
| Facility | | $9,320.45 | $12,049.58 | $18,881.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,425.17 / $15,226.45 / $20,094.82
| Facility | | $11,425.17 | $15,226.45 | $20,094.82 |