- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,255.10 / $17,250.59 / $21,245.50
| Facility | | $14,255.10 | $17,250.59 | $21,245.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,952.61 / $15,236.80 / $15,500.75
| Facility | | $13,952.61 | $15,236.80 | $15,500.75 |
- 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
- $13,613.02 / $17,599.06 / $27,577.49
| Facility | | $13,613.02 | $17,599.06 | $27,577.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,687.07 / $22,239.05 / $29,349.56
| Facility | | $16,687.07 | $22,239.05 | $29,349.56 |