- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,286.90 / $12,448.50 / $15,331.30
| Facility | | $10,286.90 | $12,448.50 | $15,331.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,068.57 / $10,995.28 / $11,185.76
| Facility | | $10,068.57 | $10,995.28 | $11,185.76 |
- 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
- $9,823.52 / $12,699.95 / $19,900.65
| Facility | | $9,823.52 | $12,699.95 | $19,900.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,041.84 / $16,048.29 / $21,179.42
| Facility | | $12,041.84 | $16,048.29 | $21,179.42 |