- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,123.70 / $11,040.90 / $13,597.80
| Facility | | $9,123.70 | $11,040.90 | $13,597.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,930.08 / $9,752.00 / $9,920.94
| Facility | | $8,930.08 | $9,752.00 | $9,920.94 |
- 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
- $8,712.74 / $11,263.92 / $17,650.41
| Facility | | $8,712.74 | $11,263.92 | $17,650.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,680.22 / $14,233.65 / $18,784.59
| Facility | | $10,680.22 | $14,233.65 | $18,784.59 |