- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,415.70 / $12,604.40 / $15,523.30
| Facility | | $10,415.70 | $12,604.40 | $15,523.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,194.65 / $11,132.96 / $11,325.83
| Facility | | $10,194.65 | $11,132.96 | $11,325.83 |
- 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
- $9,946.53 / $12,858.98 / $20,149.84
| Facility | | $9,946.53 | $12,858.98 | $20,149.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,192.63 / $16,249.25 / $21,444.63
| Facility | | $12,192.63 | $16,249.25 | $21,444.63 |