- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,775.20 / $13,039.40 / $16,059.10
| Facility | | $10,775.20 | $13,039.40 | $16,059.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,546.55 / $11,517.25 / $11,716.77
| Facility | | $10,546.55 | $11,517.25 | $11,716.77 |
- 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
- $10,289.86 / $13,302.84 / $20,845.38
| Facility | | $10,289.86 | $13,302.84 | $20,845.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,613.49 / $16,810.14 / $22,184.85
| Facility | | $12,613.49 | $16,810.14 | $22,184.85 |