- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,838.60 / $17,956.70 / $22,115.20
| Facility | | $14,838.60 | $17,956.70 | $22,115.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,523.73 / $15,860.49 / $16,135.25
| Facility | | $14,523.73 | $15,860.49 | $16,135.25 |
- 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
- $14,170.25 / $18,319.43 / $28,706.33
| Facility | | $14,170.25 | $18,319.43 | $28,706.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,370.13 / $23,149.37 / $30,550.93
| Facility | | $17,370.13 | $23,149.37 | $30,550.93 |