- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,706.50 / $15,376.50 / $18,937.40
| Facility | | $12,706.50 | $15,376.50 | $18,937.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,436.82 / $13,581.50 / $13,816.78
| Facility | | $12,436.82 | $13,581.50 | $13,816.78 |
- 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
- $12,134.12 / $15,687.12 / $24,581.51
| Facility | | $12,134.12 | $15,687.12 | $24,581.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,874.22 / $19,823.03 / $26,161.07
| Facility | | $14,874.22 | $19,823.03 | $26,161.07 |