- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,825.20 / $13,099.90 / $16,133.60
| Facility | | $10,825.20 | $13,099.90 | $16,133.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,595.47 / $11,570.68 / $11,771.12
| Facility | | $10,595.47 | $11,570.68 | $11,771.12 |
- 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
- $10,337.60 / $13,364.55 / $20,942.08
| Facility | | $10,337.60 | $13,364.55 | $20,942.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,672.00 / $16,888.12 / $22,287.77
| Facility | | $12,672.00 | $16,888.12 | $22,287.77 |