- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,004.00 / $12,033.20 / $15,188.10
| Facility | | $7,004.00 | $12,033.20 | $15,188.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,356.00 / $10,892.53 / $11,081.23
| Facility | | $5,356.00 | $10,892.53 | $11,081.23 |
- 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
- $5,700.00 / $12,054.40 / $19,714.68
| Facility | | $5,700.00 | $12,054.40 | $19,714.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $12,565.37 / $19,714.68
| Facility | | $5,700.00 | $12,565.37 | $19,714.68 |