- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,116.70 / $17,083.09 / $21,039.20
| Facility | | $14,116.70 | $17,083.09 | $21,039.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,817.12 / $15,088.84 / $15,350.23
| Facility | | $13,817.12 | $15,088.84 | $15,350.23 |
- 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
- $13,480.83 / $17,428.16 / $27,309.69
| Facility | | $13,480.83 | $17,428.16 | $27,309.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,525.03 / $22,023.09 / $29,064.55
| Facility | | $16,525.03 | $22,023.09 | $29,064.55 |