- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,499.30 / $12,705.60 / $15,648.00
| Facility | | $10,499.30 | $12,705.60 | $15,648.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,276.51 / $11,222.36 / $11,416.77
| Facility | | $10,276.51 | $11,222.36 | $11,416.77 |
- 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
- $10,026.40 / $12,962.23 / $20,311.64
| Facility | | $10,026.40 | $12,962.23 | $20,311.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,290.53 / $16,379.72 / $21,616.82
| Facility | | $12,290.53 | $16,379.72 | $21,616.82 |