- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,604.80 / $14,043.40 / $17,295.59
| Facility | | $11,604.80 | $14,043.40 | $17,295.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,358.54 / $12,403.98 / $12,618.86
| Facility | | $11,358.54 | $12,403.98 | $12,618.86 |
- 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
- $11,082.10 / $14,327.05 / $22,450.30
| Facility | | $11,082.10 | $14,327.05 | $22,450.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,584.62 / $18,104.38 / $23,892.90
| Facility | | $13,584.62 | $18,104.38 | $23,892.90 |