- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,300.10 / $13,674.60 / $16,841.40
| Facility | | $11,300.10 | $13,674.60 | $16,841.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,060.28 / $12,078.26 / $12,287.50
| Facility | | $11,060.28 | $12,078.26 | $12,287.50 |
- 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
- $10,791.09 / $13,950.83 / $21,860.77
| Facility | | $10,791.09 | $13,950.83 | $21,860.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,227.90 / $17,628.97 / $23,265.50
| Facility | | $13,227.90 | $17,628.97 | $23,265.50 |