- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.18 / $11,861.10 / $15,352.80
| Facility | | $4,881.18 | $11,861.10 | $15,352.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,082.68 / $11,010.69 / $11,201.43
| Facility | | $10,082.68 | $11,010.69 | $11,201.43 |
- 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
- $3,823.00 / $12,185.16 / $19,928.55
| Facility | | $3,823.00 | $12,185.16 | $19,928.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $12,701.67 / $19,928.55
| Facility | | $3,800.00 | $12,701.67 | $19,928.55 |