- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,429.10 / $12,620.60 / $15,543.40
| Facility | | $10,429.10 | $12,620.60 | $15,543.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,207.82 / $11,147.35 / $11,340.46
| Facility | | $10,207.82 | $11,147.35 | $11,340.46 |
- 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
- $9,959.37 / $12,875.59 / $20,175.89
| Facility | | $9,959.37 | $12,875.59 | $20,175.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,208.38 / $16,270.25 / $21,472.34
| Facility | | $12,208.38 | $16,270.25 | $21,472.34 |