- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,341.20 / $14,934.40 / $18,393.00
| Facility | | $12,341.20 | $14,934.40 | $18,393.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,079.27 / $13,191.05 / $13,419.56
| Facility | | $12,079.27 | $13,191.05 | $13,419.56 |
- 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
- $11,785.28 / $15,236.14 / $23,874.83
| Facility | | $11,785.28 | $15,236.14 | $23,874.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,446.60 / $19,253.15 / $25,408.97
| Facility | | $14,446.60 | $19,253.15 | $25,408.97 |