- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,046.79 / $10,947.80 / $13,483.10
| Facility | | $9,046.79 | $10,947.80 | $13,483.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,854.81 / $9,669.79 / $9,837.32
| Facility | | $8,854.81 | $9,669.79 | $9,837.32 |
- 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
- $8,639.29 / $11,168.97 / $17,501.64
| Facility | | $8,639.29 | $11,168.97 | $17,501.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,590.20 / $14,113.68 / $18,626.25
| Facility | | $10,590.20 | $14,113.68 | $18,626.25 |