- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,006.40 / $15,739.40 / $19,384.40
| Facility | | $13,006.40 | $15,739.40 | $19,384.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,730.38 / $13,902.08 / $14,142.91
| Facility | | $12,730.38 | $13,902.08 | $14,142.91 |
- 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
- $12,420.54 / $16,057.40 / $25,161.74
| Facility | | $12,420.54 | $16,057.40 | $25,161.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,225.31 / $20,290.93 / $26,778.58
| Facility | | $15,225.31 | $20,290.93 | $26,778.58 |