- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,592.81 / $11,608.60 / $14,296.90
| Facility | | $9,592.81 | $11,608.60 | $14,296.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,389.24 / $10,253.42 / $10,431.04
| Facility | | $9,389.24 | $10,253.42 | $10,431.04 |
- 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
- $9,160.71 / $11,843.08 / $18,557.95
| Facility | | $9,160.71 | $11,843.08 | $18,557.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,160.71 / $12,903.00 / $17,508.16
| Facility | | $9,160.71 | $12,903.00 | $17,508.16 |