- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,709.10 / $16,589.80 / $20,431.70
| Facility | | $13,709.10 | $16,589.80 | $20,431.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,418.17 / $14,653.18 / $14,907.02
| Facility | | $13,418.17 | $14,653.18 | $14,907.02 |
- 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
- $13,091.60 / $16,924.95 / $26,521.18
| Facility | | $13,091.60 | $16,924.95 | $26,521.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,047.90 / $21,387.22 / $28,225.37
| Facility | | $16,047.90 | $21,387.22 | $28,225.37 |