- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,757.20 / $11,807.50 / $14,541.90
| Facility | | $9,757.20 | $11,807.50 | $14,541.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,550.14 / $10,429.12 / $10,609.80
| Facility | | $9,550.14 | $10,429.12 | $10,609.80 |
- 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
- $9,317.70 / $12,046.02 / $18,875.96
| Facility | | $9,317.70 | $12,046.02 | $18,875.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,317.70 / $13,124.00 / $17,808.18
| Facility | | $9,317.70 | $13,124.00 | $17,808.18 |