- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,748.30 / $17,847.30 / $21,980.50
| Facility | | $14,748.30 | $17,847.30 | $21,980.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,435.29 / $15,763.91 / $16,036.99
| Facility | | $14,435.29 | $15,763.91 | $16,036.99 |
- 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
- $14,083.96 / $18,207.89 / $28,531.52
| Facility | | $14,083.96 | $18,207.89 | $28,531.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,264.34 / $23,008.40 / $30,364.89
| Facility | | $17,264.34 | $23,008.40 | $30,364.89 |