- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,164.79 / $12,300.70 / $15,149.40
| Facility | | $10,164.79 | $12,300.70 | $15,149.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,949.08 / $10,864.79 / $11,053.00
| Facility | | $9,949.08 | $10,864.79 | $11,053.00 |
- 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
- $9,706.93 / $12,549.22 / $19,664.47
| Facility | | $9,706.93 | $12,549.22 | $19,664.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,898.92 / $15,857.83 / $20,928.06
| Facility | | $11,898.92 | $15,857.83 | $20,928.06 |