- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,705.50 / $15,375.30 / $18,936.00
| Facility | | $12,705.50 | $15,375.30 | $18,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,435.88 / $13,580.47 / $13,815.73
| Facility | | $12,435.88 | $13,580.47 | $13,815.73 |
- 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
- $12,133.21 / $15,685.94 / $24,579.65
| Facility | | $12,133.21 | $15,685.94 | $24,579.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,873.09 / $19,821.53 / $26,159.09
| Facility | | $14,873.09 | $19,821.53 | $26,159.09 |