- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,655.00 / $17,734.50 / $21,841.50
| Facility | | $14,655.00 | $17,734.50 | $21,841.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,344.02 / $15,664.24 / $15,935.60
| Facility | | $14,344.02 | $15,664.24 | $15,935.60 |
- 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
- $13,994.91 / $18,092.77 / $28,351.13
| Facility | | $13,994.91 | $18,092.77 | $28,351.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,155.20 / $22,862.93 / $30,172.90
| Facility | | $17,155.20 | $22,862.93 | $30,172.90 |