- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,756.00 / $17,856.70 / $21,991.90
| Facility | | $14,756.00 | $17,856.70 | $21,991.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,442.82 / $15,772.13 / $16,045.36
| Facility | | $14,442.82 | $15,772.13 | $16,045.36 |
- 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
- $14,091.30 / $18,217.38 / $28,546.40
| Facility | | $14,091.30 | $18,217.38 | $28,546.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,273.36 / $23,020.40 / $30,380.72
| Facility | | $17,273.36 | $23,020.40 | $30,380.72 |