- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,467.60 / $17,507.70 / $21,562.10
| Facility | | $14,467.60 | $17,507.70 | $21,562.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,160.55 / $15,463.88 / $15,731.77
| Facility | | $14,160.55 | $15,463.88 | $15,731.77 |
- 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
- $13,815.90 / $17,861.34 / $27,988.49
| Facility | | $13,815.90 | $17,861.34 | $27,988.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,935.77 / $22,570.49 / $29,786.96
| Facility | | $16,935.77 | $22,570.49 | $29,786.96 |