- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,004.00 / $13,316.30 / $16,400.09
| Facility | | $11,004.00 | $13,316.30 | $16,400.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,770.48 / $11,761.79 / $11,965.55
| Facility | | $10,770.48 | $11,761.79 | $11,965.55 |
- 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
- $10,508.35 / $13,585.30 / $21,287.99
| Facility | | $10,508.35 | $13,585.30 | $21,287.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,881.31 / $17,167.07 / $22,655.90
| Facility | | $12,881.31 | $17,167.07 | $22,655.90 |