- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,417.80 / $16,237.30 / $19,997.59
| Facility | | $13,417.80 | $16,237.30 | $19,997.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,133.08 / $14,341.85 / $14,590.30
| Facility | | $13,133.08 | $14,341.85 | $14,590.30 |
- 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
- $12,813.44 / $16,565.34 / $25,957.69
| Facility | | $12,813.44 | $16,565.34 | $25,957.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,706.94 / $20,932.81 / $27,625.67
| Facility | | $15,706.94 | $20,932.81 | $27,625.67 |