- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,926.80 / $14,433.10 / $17,775.50
| Facility | | $11,926.80 | $14,433.10 | $17,775.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,673.75 / $12,748.19 / $12,969.04
| Facility | | $11,673.75 | $12,748.19 | $12,969.04 |
- 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
- $11,389.63 / $14,724.63 / $23,073.30
| Facility | | $11,389.63 | $14,724.63 | $23,073.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,961.60 / $18,606.78 / $24,555.93
| Facility | | $13,961.60 | $18,606.78 | $24,555.93 |