- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,581.50 / $15,225.30 / $18,751.20
| Facility | | $12,581.50 | $15,225.30 | $18,751.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,314.50 / $13,447.92 / $13,680.89
| Facility | | $12,314.50 | $13,447.92 | $13,680.89 |
- 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
- $12,014.78 / $15,532.84 / $24,339.75
| Facility | | $12,014.78 | $15,532.84 | $24,339.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,727.93 / $19,628.07 / $25,903.77
| Facility | | $14,727.93 | $19,628.07 | $25,903.77 |