- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,249.10 / $13,612.90 / $16,765.50
| Facility | | $11,249.10 | $13,612.90 | $16,765.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,010.41 / $12,023.81 / $12,232.10
| Facility | | $11,010.41 | $12,023.81 | $12,232.10 |
- 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
- $10,742.44 / $13,887.93 / $21,762.21
| Facility | | $10,742.44 | $13,887.93 | $21,762.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,168.26 / $17,549.49 / $23,160.60
| Facility | | $13,168.26 | $17,549.49 | $23,160.60 |