- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,035.20 / $15,774.30 / $19,427.40
| Facility | | $13,035.20 | $15,774.30 | $19,427.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,758.60 / $13,932.90 / $14,174.27
| Facility | | $12,758.60 | $13,932.90 | $14,174.27 |
- 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
- $12,448.08 / $16,093.01 / $25,217.53
| Facility | | $12,448.08 | $16,093.01 | $25,217.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,259.07 / $20,335.93 / $26,837.95
| Facility | | $15,259.07 | $20,335.93 | $26,837.95 |