- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,706.90 / $17,797.30 / $21,918.90
| Facility | | $14,706.90 | $17,797.30 | $21,918.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,394.83 / $15,719.72 / $15,992.04
| Facility | | $14,394.83 | $15,719.72 | $15,992.04 |
- 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
- $14,044.48 / $18,156.84 / $28,451.55
| Facility | | $14,044.48 | $18,156.84 | $28,451.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,215.96 / $22,943.91 / $30,279.78
| Facility | | $17,215.96 | $22,943.91 | $30,279.78 |