- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,182.80 / $13,532.70 / $16,666.59
| Facility | | $11,182.80 | $13,532.70 | $16,666.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,945.49 / $11,952.91 / $12,159.97
| Facility | | $10,945.49 | $11,952.91 | $12,159.97 |
- 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
- $10,679.09 / $13,806.04 / $21,633.89
| Facility | | $10,679.09 | $13,806.04 | $21,633.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,090.61 / $17,446.00 / $23,024.03
| Facility | | $13,090.61 | $17,446.00 | $23,024.03 |