- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,436.60 / $13,839.80 / $17,044.80
| Facility | | $11,436.60 | $13,839.80 | $17,044.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,193.89 / $12,224.17 / $12,435.93
| Facility | | $11,193.89 | $12,224.17 | $12,435.93 |
- 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
- $10,921.45 / $14,119.36 / $22,124.85
| Facility | | $10,921.45 | $14,119.36 | $22,124.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,387.69 / $17,841.93 / $23,546.54
| Facility | | $13,387.69 | $17,841.93 | $23,546.54 |