- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,712.98 / $11,754.00 / $14,476.00
| Facility | | $9,712.98 | $11,754.00 | $14,476.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,506.85 / $10,381.86 / $10,561.71
| Facility | | $9,506.85 | $10,381.86 | $10,561.71 |
- 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
- $9,275.46 / $11,991.43 / $18,790.41
| Facility | | $9,275.46 | $11,991.43 | $18,790.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,370.03 / $15,152.97 / $19,997.84
| Facility | | $11,370.03 | $15,152.97 | $19,997.84 |