- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,984.80 / $13,293.00 / $16,371.50
| Facility | | $10,984.80 | $13,293.00 | $16,371.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,751.66 / $11,741.24 / $11,944.64
| Facility | | $10,751.66 | $11,741.24 | $11,944.64 |
- 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
- $10,489.99 / $13,561.56 / $21,250.79
| Facility | | $10,489.99 | $13,561.56 | $21,250.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.80 / $17,137.07 / $22,616.32
| Facility | | $12,858.80 | $17,137.07 | $22,616.32 |