- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,571.40 / $12,792.80 / $15,755.40
| Facility | | $10,571.40 | $12,792.80 | $15,755.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,347.08 / $11,299.42 / $11,495.16
| Facility | | $10,347.08 | $11,299.42 | $11,495.16 |
- 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
- $10,095.25 / $13,051.24 / $20,451.12
| Facility | | $10,095.25 | $13,051.24 | $20,451.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,374.92 / $16,492.20 / $21,765.26
| Facility | | $12,374.92 | $16,492.20 | $21,765.26 |