- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,087.60 / $13,417.50 / $16,524.80
| Facility | | $11,087.60 | $13,417.50 | $16,524.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,852.34 / $11,851.19 / $12,056.49
| Facility | | $10,852.34 | $11,851.19 | $12,056.49 |
- 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
- $10,588.21 / $13,688.55 / $21,449.78
| Facility | | $10,588.21 | $13,688.55 | $21,449.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,979.21 / $17,297.54 / $22,828.09
| Facility | | $12,979.21 | $17,297.54 | $22,828.09 |