- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,723.10 / $14,186.40 / $17,471.80
| Facility | | $11,723.10 | $14,186.40 | $17,471.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,474.28 / $12,530.36 / $12,747.43
| Facility | | $11,474.28 | $12,530.36 | $12,747.43 |
- 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
- $11,195.01 / $14,473.03 / $22,679.04
| Facility | | $11,195.01 | $14,473.03 | $22,679.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,723.03 / $18,288.84 / $24,136.34
| Facility | | $13,723.03 | $18,288.84 | $24,136.34 |