- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,422.40 / $17,453.00 / $21,494.80
| Facility | | $14,422.40 | $17,453.00 | $21,494.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,116.32 / $15,415.58 / $15,682.64
| Facility | | $14,116.32 | $15,415.58 | $15,682.64 |
- 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
- $13,772.75 / $17,805.56 / $27,901.08
| Facility | | $13,772.75 | $17,805.56 | $27,901.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,882.88 / $22,500.00 / $29,693.94
| Facility | | $16,882.88 | $22,500.00 | $29,693.94 |