- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,243.40 / $13,606.00 / $16,756.90
| Facility | | $11,243.40 | $13,606.00 | $16,756.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,004.77 / $12,017.64 / $12,225.83
| Facility | | $11,004.77 | $12,017.64 | $12,225.83 |
- 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
- $10,736.93 / $13,880.81 / $21,751.05
| Facility | | $10,736.93 | $13,880.81 | $21,751.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,161.51 / $17,540.49 / $23,148.72
| Facility | | $13,161.51 | $17,540.49 | $23,148.72 |