- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,454.60 / $15,071.70 / $18,562.09
| Facility | | $12,454.60 | $15,071.70 | $18,562.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,190.30 / $13,312.29 / $13,542.91
| Facility | | $12,190.30 | $13,312.29 | $13,542.91 |
- 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
- $11,893.61 / $15,376.18 / $24,094.27
| Facility | | $11,893.61 | $15,376.18 | $24,094.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,579.39 / $19,430.11 / $25,642.52
| Facility | | $14,579.39 | $19,430.11 | $25,642.52 |