- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,502.90 / $13,920.00 / $17,143.70
| Facility | | $11,502.90 | $13,920.00 | $17,143.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.81 / $12,295.07 / $12,508.06
| Facility | | $11,258.81 | $12,295.07 | $12,508.06 |
- 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
- $10,984.79 / $14,201.25 / $22,253.17
| Facility | | $10,984.79 | $14,201.25 | $22,253.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,465.34 / $17,945.41 / $23,683.11
| Facility | | $13,465.34 | $17,945.41 | $23,683.11 |