- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,875.20 / $13,160.40 / $16,208.10
| Facility | | $10,875.20 | $13,160.40 | $16,208.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,644.40 / $11,624.11 / $11,825.48
| Facility | | $10,644.40 | $11,624.11 | $11,825.48 |
- 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
- $10,385.33 / $13,426.27 / $21,038.79
| Facility | | $10,385.33 | $13,426.27 | $21,038.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,730.52 / $16,966.11 / $22,390.69
| Facility | | $12,730.52 | $16,966.11 | $22,390.69 |