- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,377.20 / $12,557.80 / $15,466.00
| Facility | | $10,377.20 | $12,557.80 | $15,466.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,157.02 / $11,091.86 / $11,284.01
| Facility | | $10,157.02 | $11,091.86 | $11,284.01 |
- 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
- $9,909.81 / $12,811.51 / $20,075.46
| Facility | | $9,909.81 | $12,811.51 | $20,075.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,909.81 / $13,958.00 / $18,939.83
| Facility | | $9,909.81 | $13,958.00 | $18,939.83 |