- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,560.80 / $12,780.00 / $15,739.60
| Facility | | $10,560.80 | $12,780.00 | $15,739.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,336.73 / $11,288.12 / $11,483.67
| Facility | | $10,336.73 | $11,288.12 | $11,483.67 |
- 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
- $10,085.15 / $13,038.18 / $20,430.66
| Facility | | $10,085.15 | $13,038.18 | $20,430.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,362.55 / $16,475.70 / $21,743.49
| Facility | | $12,362.55 | $16,475.70 | $21,743.49 |