- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,696.60 / $16,574.70 / $20,413.09
| Facility | | $13,696.60 | $16,574.70 | $20,413.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,405.94 / $14,639.82 / $14,893.43
| Facility | | $13,405.94 | $14,639.82 | $14,893.43 |
- 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
- $13,079.66 / $16,909.53 / $26,497.01
| Facility | | $13,079.66 | $16,909.53 | $26,497.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,033.27 / $21,367.73 / $28,199.64
| Facility | | $16,033.27 | $21,367.73 | $28,199.64 |