- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,295.50 / $12,458.90 / $15,344.20
| Facility | | $10,295.50 | $12,458.90 | $15,344.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,077.04 / $11,004.53 / $11,195.16
| Facility | | $10,077.04 | $11,004.53 | $11,195.16 |
- 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
- $9,831.78 / $12,710.63 / $19,917.39
| Facility | | $9,831.78 | $12,710.63 | $19,917.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,051.96 / $16,061.79 / $21,197.23
| Facility | | $12,051.96 | $16,061.79 | $21,197.23 |