- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,451.50 / $16,278.10 / $20,047.80
| Facility | | $13,451.50 | $16,278.10 | $20,047.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,166.01 / $14,377.81 / $14,626.88
| Facility | | $13,166.01 | $14,377.81 | $14,626.88 |
- 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
- $12,845.57 / $16,606.89 / $26,022.78
| Facility | | $12,845.57 | $16,606.89 | $26,022.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,746.32 / $20,985.30 / $27,694.95
| Facility | | $15,746.32 | $20,985.30 | $27,694.95 |