- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,336.10 / $16,138.50 / $19,875.80
| Facility | | $13,336.10 | $16,138.50 | $19,875.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,053.11 / $14,254.51 / $14,501.45
| Facility | | $13,053.11 | $14,254.51 | $14,501.45 |
- 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
- $12,735.41 / $16,464.48 / $25,799.62
| Facility | | $12,735.41 | $16,464.48 | $25,799.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,611.29 / $20,805.34 / $27,457.44
| Facility | | $15,611.29 | $20,805.34 | $27,457.44 |