- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,783.15 / $11,838.90 / $14,580.60
| Facility | | $9,783.15 | $11,838.90 | $14,580.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,575.54 / $10,456.87 / $10,638.02
| Facility | | $9,575.54 | $10,456.87 | $10,638.02 |
- 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
- $9,342.49 / $12,078.06 / $18,926.16
| Facility | | $9,342.49 | $12,078.06 | $18,926.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,452.18 / $15,262.45 / $20,142.32
| Facility | | $11,452.18 | $15,262.45 | $20,142.32 |