- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,873.30 / $13,158.10 / $16,205.30
| Facility | | $10,873.30 | $13,158.10 | $16,205.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,642.52 / $11,622.05 / $11,823.39
| Facility | | $10,642.52 | $11,622.05 | $11,823.39 |
- 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
- $10,383.50 / $13,423.89 / $21,035.07
| Facility | | $10,383.50 | $13,423.89 | $21,035.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,728.27 / $16,963.11 / $22,386.73
| Facility | | $12,728.27 | $16,963.11 | $22,386.73 |