- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,177.29 / $12,315.90 / $15,168.00
| Facility | | $10,177.29 | $12,315.90 | $15,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,961.31 / $10,878.14 / $11,066.59
| Facility | | $9,961.31 | $10,878.14 | $11,066.59 |
- 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
- $9,718.87 / $12,564.65 / $19,688.64
| Facility | | $9,718.87 | $12,564.65 | $19,688.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,913.55 / $15,877.32 / $20,953.79
| Facility | | $11,913.55 | $15,877.32 | $20,953.79 |