- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,403.20 / $17,429.70 / $21,466.10
| Facility | | $14,403.20 | $17,429.70 | $21,466.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,097.50 / $15,395.03 / $15,661.73
| Facility | | $14,097.50 | $15,395.03 | $15,661.73 |
- 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
- $13,754.39 / $17,781.82 / $27,863.89
| Facility | | $13,754.39 | $17,781.82 | $27,863.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,754.39 / $19,373.00 / $26,287.67
| Facility | | $13,754.39 | $19,373.00 | $26,287.67 |