- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,427.46 / $11,408.50 / $14,050.50
| Facility | | $9,427.46 | $11,408.50 | $14,050.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,227.41 / $10,076.69 / $10,251.26
| Facility | | $9,227.41 | $10,076.69 | $10,251.26 |
- 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
- $9,002.83 / $11,638.95 / $18,238.08
| Facility | | $9,002.83 | $11,638.95 | $18,238.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,035.82 / $14,707.56 / $19,410.00
| Facility | | $11,035.82 | $14,707.56 | $19,410.00 |