- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,575.70 / $15,218.30 / $18,742.59
| Facility | | $12,575.70 | $15,218.30 | $18,742.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,308.85 / $13,441.76 / $13,674.61
| Facility | | $12,308.85 | $13,441.76 | $13,674.61 |
- 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
- $12,009.28 / $15,525.72 / $24,328.60
| Facility | | $12,009.28 | $15,525.72 | $24,328.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,721.17 / $19,619.08 / $25,891.89
| Facility | | $14,721.17 | $19,619.08 | $25,891.89 |