- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,928.80 / $14,435.40 / $17,778.40
| Facility | | $11,928.80 | $14,435.40 | $17,778.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,675.63 / $12,750.25 / $12,971.13
| Facility | | $11,675.63 | $12,750.25 | $12,971.13 |
- 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
- $11,391.46 / $14,727.00 / $23,077.02
| Facility | | $11,391.46 | $14,727.00 | $23,077.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,963.85 / $18,609.78 / $24,559.89
| Facility | | $13,963.85 | $18,609.78 | $24,559.89 |