- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,550.20 / $17,607.70 / $21,685.30
| Facility | | $14,550.20 | $17,607.70 | $21,685.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,241.46 / $15,552.24 / $15,821.66
| Facility | | $14,241.46 | $15,552.24 | $15,821.66 |
- 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
- $13,894.85 / $17,963.40 / $28,148.42
| Facility | | $13,894.85 | $17,963.40 | $28,148.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,032.54 / $22,699.46 / $29,957.17
| Facility | | $17,032.54 | $22,699.46 | $29,957.17 |