- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,953.29 / $12,044.80 / $14,834.20
| Facility | | $9,953.29 | $12,044.80 | $14,834.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,742.08 / $10,638.74 / $10,823.04
| Facility | | $9,742.08 | $10,638.74 | $10,823.04 |
- 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
- $9,504.96 / $12,288.13 / $19,255.33
| Facility | | $9,504.96 | $12,288.13 | $19,255.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,651.36 / $15,527.89 / $20,492.64
| Facility | | $11,651.36 | $15,527.89 | $20,492.64 |