- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,019.40 / $13,334.90 / $16,423.00
| Facility | | $11,019.40 | $13,334.90 | $16,423.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,785.54 / $11,778.23 / $11,982.27
| Facility | | $10,785.54 | $11,778.23 | $11,982.27 |
- 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
- $10,523.03 / $13,604.29 / $21,317.74
| Facility | | $10,523.03 | $13,604.29 | $21,317.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,899.31 / $17,191.06 / $22,687.57
| Facility | | $12,899.31 | $17,191.06 | $22,687.57 |