- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,919.40 / $18,054.40 / $22,235.50
| Facility | | $14,919.40 | $18,054.40 | $22,235.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,602.77 / $15,946.80 / $16,223.06
| Facility | | $14,602.77 | $15,946.80 | $16,223.06 |
- 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
- $14,247.36 / $18,419.14 / $28,862.54
| Facility | | $14,247.36 | $18,419.14 | $28,862.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,464.66 / $23,275.34 / $30,717.18
| Facility | | $17,464.66 | $23,275.34 | $30,717.18 |