- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,635.30 / $15,290.40 / $18,831.40
| Facility | | $12,635.30 | $15,290.40 | $18,831.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,367.19 / $13,505.46 / $13,739.42
| Facility | | $12,367.19 | $13,505.46 | $13,739.42 |
- 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
- $12,066.19 / $15,599.30 / $24,443.90
| Facility | | $12,066.19 | $15,599.30 | $24,443.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,790.94 / $19,712.06 / $26,014.60
| Facility | | $14,790.94 | $19,712.06 | $26,014.60 |