- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,408.40 / $19,856.40 / $24,454.80
| Facility | | $16,408.40 | $19,856.40 | $24,454.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,060.22 / $17,538.40 / $17,842.23
| Facility | | $16,060.22 | $17,538.40 | $17,842.23 |
- 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
- $15,669.34 / $20,257.49 / $31,743.22
| Facility | | $15,669.34 | $20,257.49 | $31,743.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,207.75 / $25,598.38 / $33,782.96
| Facility | | $19,207.75 | $25,598.38 | $33,782.96 |