- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,096.80 / $15,848.80 / $19,519.09
| Facility | | $13,096.80 | $15,848.80 | $19,519.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,818.82 / $13,998.66 / $14,241.17
| Facility | | $12,818.82 | $13,998.66 | $14,241.17 |
- 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
- $12,506.83 / $16,168.96 / $25,336.55
| Facility | | $12,506.83 | $16,168.96 | $25,336.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,331.09 / $20,431.91 / $26,964.62
| Facility | | $15,331.09 | $20,431.91 | $26,964.62 |