- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,735.80 / $12,991.70 / $16,000.40
| Facility | | $10,735.80 | $12,991.70 | $16,000.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,507.97 / $11,475.12 / $11,673.91
| Facility | | $10,507.97 | $11,475.12 | $11,673.91 |
- 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
- $10,252.21 / $13,254.18 / $20,769.13
| Facility | | $10,252.21 | $13,254.18 | $20,769.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,567.35 / $16,748.65 / $22,103.71
| Facility | | $12,567.35 | $16,748.65 | $22,103.71 |