- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,229.20 / $12,378.70 / $15,245.40
| Facility | | $10,229.20 | $12,378.70 | $15,245.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,012.12 / $10,933.63 / $11,123.04
| Facility | | $10,012.12 | $10,933.63 | $11,123.04 |
- 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
- $9,768.44 / $12,628.74 / $19,789.07
| Facility | | $9,768.44 | $12,628.74 | $19,789.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,974.32 / $15,958.31 / $21,060.67
| Facility | | $11,974.32 | $15,958.31 | $21,060.67 |