- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,004.00 / $10,985.00 / $13,736.70
| Facility | | $7,004.00 | $10,985.00 | $13,736.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.00 / $9,851.67 / $10,022.34
| Facility | | $3,904.00 | $9,851.67 | $10,022.34 |
- 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 / $11,219.88 / $17,830.80
| Facility | | $5,700.00 | $11,219.88 | $17,830.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,334.82 / $11,595.73 / $16,822.15
| Facility | | $7,334.82 | $11,595.73 | $16,822.15 |