- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,924.70 / $15,640.60 / $19,262.70
| Facility | | $12,924.70 | $15,640.60 | $19,262.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,650.40 / $13,814.74 / $14,054.06
| Facility | | $12,650.40 | $13,814.74 | $14,054.06 |
- 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
- $12,342.51 / $15,956.53 / $25,003.67
| Facility | | $12,342.51 | $15,956.53 | $25,003.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,129.66 / $20,163.47 / $26,610.34
| Facility | | $15,129.66 | $20,163.47 | $26,610.34 |