- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,143.40 / $13,485.00 / $16,607.90
| Facility | | $11,143.40 | $13,485.00 | $16,607.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,906.91 / $11,910.78 / $12,117.12
| Facility | | $10,906.91 | $11,910.78 | $12,117.12 |
- 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
- $10,641.46 / $13,757.39 / $21,557.64
| Facility | | $10,641.46 | $13,757.39 | $21,557.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,044.48 / $17,384.52 / $22,942.89
| Facility | | $13,044.48 | $17,384.52 | $22,942.89 |