- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,012.90 / $12,116.90 / $14,923.00
| Facility | | $10,012.90 | $12,116.90 | $14,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,800.41 / $10,702.44 / $10,887.84
| Facility | | $9,800.41 | $10,702.44 | $10,887.84 |
- 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
- $9,561.89 / $12,361.71 / $19,370.64
| Facility | | $9,561.89 | $12,361.71 | $19,370.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,721.12 / $15,620.88 / $20,615.34
| Facility | | $11,721.12 | $15,620.88 | $20,615.34 |