- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,494.70 / $16,330.40 / $20,112.20
| Facility | | $13,494.70 | $16,330.40 | $20,112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,208.35 / $14,424.05 / $14,673.92
| Facility | | $13,208.35 | $14,424.05 | $14,673.92 |
- 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
- $12,886.88 / $16,660.30 / $26,106.47
| Facility | | $12,886.88 | $16,660.30 | $26,106.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,796.96 / $21,052.79 / $27,784.01
| Facility | | $15,796.96 | $21,052.79 | $27,784.01 |