- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,453.40 / $16,280.40 / $20,050.59
| Facility | | $13,453.40 | $16,280.40 | $20,050.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,167.90 / $14,379.86 / $14,628.97
| Facility | | $13,167.90 | $14,379.86 | $14,628.97 |
- 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
- $12,847.41 / $16,609.27 / $26,026.50
| Facility | | $12,847.41 | $16,609.27 | $26,026.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,748.57 / $20,988.30 / $27,698.90
| Facility | | $15,748.57 | $20,988.30 | $27,698.90 |