- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,022.20 / $18,178.90 / $22,388.80
| Facility | | $15,022.20 | $18,178.90 | $22,388.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,703.44 / $16,056.74 / $16,334.90
| Facility | | $14,703.44 | $16,056.74 | $16,334.90 |
- 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
- $14,345.59 / $18,546.12 / $29,061.53
| Facility | | $14,345.59 | $18,546.12 | $29,061.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,585.06 / $23,435.81 / $30,928.96
| Facility | | $17,585.06 | $23,435.81 | $30,928.96 |