- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,034.50 / $14,563.40 / $17,936.00
| Facility | | $12,034.50 | $14,563.40 | $17,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,779.13 / $12,863.27 / $13,086.11
| Facility | | $11,779.13 | $12,863.27 | $13,086.11 |
- 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
- $11,492.44 / $14,857.55 / $23,281.58
| Facility | | $11,492.44 | $14,857.55 | $23,281.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,087.63 / $18,774.74 / $24,777.60
| Facility | | $14,087.63 | $18,774.74 | $24,777.60 |