- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,004.00 / $10,973.50 / $13,722.40
| Facility | | $7,004.00 | $10,973.50 | $13,722.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.00 / $9,841.40 / $10,011.87
| Facility | | $3,904.00 | $9,841.40 | $10,011.87 |
- 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 / $11,208.18 / $17,812.21
| Facility | | $5,700.00 | $11,208.18 | $17,812.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $11,399.00 / $17,812.21
| Facility | | $5,700.00 | $11,399.00 | $17,812.21 |