- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,452.20 / $17,489.09 / $21,539.20
| Facility | | $14,452.20 | $17,489.09 | $21,539.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,145.49 / $15,447.44 / $15,715.04
| Facility | | $14,145.49 | $15,447.44 | $15,715.04 |
- 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
- $13,801.21 / $17,842.34 / $27,958.73
| Facility | | $13,801.21 | $17,842.34 | $27,958.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,917.75 / $22,546.49 / $29,755.29
| Facility | | $16,917.75 | $22,546.49 | $29,755.29 |