- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,360.90 / $12,538.00 / $15,441.60
| Facility | | $10,360.90 | $12,538.00 | $15,441.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,141.02 / $11,074.40 / $11,266.24
| Facility | | $10,141.02 | $11,074.40 | $11,266.24 |
- 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
- $9,894.20 / $12,791.33 / $20,043.84
| Facility | | $9,894.20 | $12,791.33 | $20,043.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,128.48 / $16,163.77 / $21,331.82
| Facility | | $12,128.48 | $16,163.77 | $21,331.82 |