- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,995.30 / $13,305.80 / $16,387.20
| Facility | | $10,995.30 | $13,305.80 | $16,387.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,762.01 / $11,752.55 / $11,956.14
| Facility | | $10,762.01 | $11,752.55 | $11,956.14 |
- 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
- $10,500.08 / $13,574.62 / $21,271.25
| Facility | | $10,500.08 | $13,574.62 | $21,271.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,871.18 / $17,153.57 / $22,638.09
| Facility | | $12,871.18 | $17,153.57 | $22,638.09 |