- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,464.70 / $17,504.20 / $21,557.80
| Facility | | $14,464.70 | $17,504.20 | $21,557.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,157.72 / $15,460.79 / $15,728.63
| Facility | | $14,157.72 | $15,460.79 | $15,728.63 |
- 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
- $13,813.15 / $17,857.78 / $27,982.91
| Facility | | $13,813.15 | $17,857.78 | $27,982.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,932.39 / $22,565.99 / $29,781.02
| Facility | | $16,932.39 | $22,565.99 | $29,781.02 |