- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,985.50 / $19,344.50 / $23,824.40
| Facility | | $15,985.50 | $19,344.50 | $23,824.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,646.23 / $17,086.30 / $17,382.29
| Facility | | $15,646.23 | $17,086.30 | $17,382.29 |
- 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
- $15,265.42 / $19,735.30 / $30,924.95
| Facility | | $15,265.42 | $19,735.30 | $30,924.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,712.61 / $24,938.51 / $32,912.12
| Facility | | $18,712.61 | $24,938.51 | $32,912.12 |