- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,567.60 / $12,788.20 / $15,749.70
| Facility | | $10,567.60 | $12,788.20 | $15,749.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,343.31 / $11,295.31 / $11,490.98
| Facility | | $10,343.31 | $11,295.31 | $11,490.98 |
- 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
- $10,091.57 / $13,046.49 / $20,443.68
| Facility | | $10,091.57 | $13,046.49 | $20,443.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,370.42 / $16,486.20 / $21,757.35
| Facility | | $12,370.42 | $16,486.20 | $21,757.35 |