- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,503.59 / $19,971.50 / $24,596.60
| Facility | | $16,503.59 | $19,971.50 | $24,596.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,153.37 / $17,640.12 / $17,945.71
| Facility | | $16,153.37 | $17,640.12 | $17,945.71 |
- 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
- $15,760.22 / $20,374.98 / $31,927.33
| Facility | | $15,760.22 | $20,374.98 | $31,927.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,319.15 / $25,746.85 / $33,978.91
| Facility | | $19,319.15 | $25,746.85 | $33,978.91 |