- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,260.20 / $11,206.10 / $13,801.20
| Facility | | $9,260.20 | $11,206.10 | $13,801.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,063.69 / $9,897.91 / $10,069.37
| Facility | | $9,063.69 | $9,897.91 | $10,069.37 |
- 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
- $8,843.09 / $11,432.44 / $17,914.49
| Facility | | $8,843.09 | $11,432.44 | $17,914.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,840.01 / $14,446.61 / $19,065.63
| Facility | | $10,840.01 | $14,446.61 | $19,065.63 |