- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,411.12 / $11,388.70 / $14,026.10
| Facility | | $9,411.12 | $11,388.70 | $14,026.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,211.41 / $10,059.23 / $10,233.49
| Facility | | $9,211.41 | $10,059.23 | $10,233.49 |
- 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
- $8,987.21 / $11,618.77 / $18,206.46
| Facility | | $8,987.21 | $11,618.77 | $18,206.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,016.69 / $14,682.06 / $19,376.37
| Facility | | $11,016.69 | $14,682.06 | $19,376.37 |