- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,574.10 / $14,006.10 / $17,249.70
| Facility | | $11,574.10 | $14,006.10 | $17,249.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,328.44 / $12,371.10 / $12,585.41
| Facility | | $11,328.44 | $12,371.10 | $12,585.41 |
- 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
- $11,052.72 / $14,289.07 / $22,390.79
| Facility | | $11,052.72 | $14,289.07 | $22,390.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,548.61 / $18,056.39 / $23,829.57
| Facility | | $13,548.61 | $18,056.39 | $23,829.57 |