- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,153.29 / $12,286.80 / $15,132.20
| Facility | | $10,153.29 | $12,286.80 | $15,132.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,937.79 / $10,852.46 / $11,040.46
| Facility | | $9,937.79 | $10,852.46 | $11,040.46 |
- 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
- $9,695.92 / $12,534.98 / $19,642.15
| Facility | | $9,695.92 | $12,534.98 | $19,642.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,885.42 / $15,839.83 / $20,904.31
| Facility | | $11,885.42 | $15,839.83 | $20,904.31 |