- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,670.60 / $16,543.30 / $20,374.40
| Facility | | $13,670.60 | $16,543.30 | $20,374.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,380.54 / $14,612.08 / $14,865.21
| Facility | | $13,380.54 | $14,612.08 | $14,865.21 |
- 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
- $13,054.88 / $16,877.48 / $26,446.79
| Facility | | $13,054.88 | $16,877.48 | $26,446.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,002.89 / $21,327.23 / $28,146.20
| Facility | | $16,002.89 | $21,327.23 | $28,146.20 |