- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,934.80 / $13,232.50 / $16,297.00
| Facility | | $10,934.80 | $13,232.50 | $16,297.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,702.74 / $11,687.81 / $11,890.29
| Facility | | $10,702.74 | $11,687.81 | $11,890.29 |
- 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
- $10,442.25 / $13,499.85 / $21,154.09
| Facility | | $10,442.25 | $13,499.85 | $21,154.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,800.29 / $17,059.09 / $22,513.40
| Facility | | $12,800.29 | $17,059.09 | $22,513.40 |