- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,732.90 / $17,828.70 / $21,957.60
| Facility | | $14,732.90 | $17,828.70 | $21,957.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,420.23 / $15,747.47 / $16,020.27
| Facility | | $14,420.23 | $15,747.47 | $16,020.27 |
- 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
- $14,069.27 / $18,188.90 / $28,501.76
| Facility | | $14,069.27 | $18,188.90 | $28,501.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,246.34 / $22,984.40 / $30,333.22
| Facility | | $17,246.34 | $22,984.40 | $30,333.22 |