- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,474.80 / $15,096.10 / $18,592.09
| Facility | | $12,474.80 | $15,096.10 | $18,592.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,210.06 / $13,333.87 / $13,564.86
| Facility | | $12,210.06 | $13,333.87 | $13,564.86 |
- 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
- $11,912.89 / $15,401.10 / $24,133.33
| Facility | | $11,912.89 | $15,401.10 | $24,133.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,603.02 / $19,461.61 / $25,684.08
| Facility | | $14,603.02 | $19,461.61 | $25,684.08 |