- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,457.00 / $12,654.40 / $15,584.90
| Facility | | $10,457.00 | $12,654.40 | $15,584.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,235.11 / $11,177.15 / $11,370.77
| Facility | | $10,235.11 | $11,177.15 | $11,370.77 |
- 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
- $9,986.00 / $12,910.01 / $20,229.82
| Facility | | $9,986.00 | $12,910.01 | $20,229.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,241.01 / $16,313.74 / $21,529.74
| Facility | | $12,241.01 | $16,313.74 | $21,529.74 |