- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,527.90 / $13,950.30 / $17,180.90
| Facility | | $11,527.90 | $13,950.30 | $17,180.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,283.27 / $12,321.78 / $12,535.24
| Facility | | $11,283.27 | $12,321.78 | $12,535.24 |
- 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
- $11,008.66 / $14,232.11 / $22,301.52
| Facility | | $11,008.66 | $14,232.11 | $22,301.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,494.60 / $17,984.40 / $23,734.57
| Facility | | $13,494.60 | $17,984.40 | $23,734.57 |