- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,063.79 / $12,178.60 / $14,998.90
| Facility | | $10,063.79 | $12,178.60 | $14,998.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,850.28 / $10,756.90 / $10,943.25
| Facility | | $9,850.28 | $10,756.90 | $10,943.25 |
- 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
- $9,610.54 / $12,424.61 / $19,469.20
| Facility | | $9,610.54 | $12,424.61 | $19,469.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,780.77 / $15,700.36 / $20,720.24
| Facility | | $11,780.77 | $15,700.36 | $20,720.24 |