- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,072.50 / $12,189.10 / $15,011.80
| Facility | | $10,072.50 | $12,189.10 | $15,011.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,858.75 / $10,766.15 / $10,952.65
| Facility | | $9,858.75 | $10,766.15 | $10,952.65 |
- 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
- $9,618.79 / $12,435.29 / $19,485.93
| Facility | | $9,618.79 | $12,435.29 | $19,485.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,790.89 / $15,713.86 / $20,738.06
| Facility | | $11,790.89 | $15,713.86 | $20,738.06 |