- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,648.30 / $12,885.90 / $15,870.00
| Facility | | $10,648.30 | $12,885.90 | $15,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,422.35 / $11,381.62 / $11,578.79
| Facility | | $10,422.35 | $11,381.62 | $11,578.79 |
- 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
- $10,168.69 / $13,146.18 / $20,599.90
| Facility | | $10,168.69 | $13,146.18 | $20,599.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,464.95 / $16,612.18 / $21,923.60
| Facility | | $12,464.95 | $16,612.18 | $21,923.60 |