- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,061.00 / $12,175.10 / $14,994.60
| Facility | | $10,061.00 | $12,175.10 | $14,994.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,847.45 / $10,753.82 / $10,940.11
| Facility | | $9,847.45 | $10,753.82 | $10,940.11 |
- 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
- $9,607.79 / $12,421.05 / $19,463.62
| Facility | | $9,607.79 | $12,421.05 | $19,463.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,607.79 / $13,508.47 / $19,463.62
| Facility | | $9,607.79 | $13,508.47 | $19,463.62 |