- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,261.90 / $12,418.20 / $15,294.10
| Facility | | $10,261.90 | $12,418.20 | $15,294.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,044.11 / $10,968.56 / $11,158.58
| Facility | | $10,044.11 | $10,968.56 | $11,158.58 |
- 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
- $9,799.65 / $12,669.09 / $19,852.30
| Facility | | $9,799.65 | $12,669.09 | $19,852.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,012.58 / $16,009.30 / $21,127.96
| Facility | | $12,012.58 | $16,009.30 | $21,127.96 |