- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,135.20 / $15,895.30 / $19,576.40
| Facility | | $13,135.20 | $15,895.30 | $19,576.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,856.46 / $14,039.76 / $14,282.98
| Facility | | $12,856.46 | $14,039.76 | $14,282.98 |
- 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
- $12,543.55 / $16,216.44 / $25,410.94
| Facility | | $12,543.55 | $16,216.44 | $25,410.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,376.10 / $20,491.90 / $27,043.79
| Facility | | $15,376.10 | $20,491.90 | $27,043.79 |