- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,302.90 / $18,518.59 / $22,807.20
| Facility | | $15,302.90 | $18,518.59 | $22,807.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,978.19 / $16,356.77 / $16,640.13
| Facility | | $14,978.19 | $16,356.77 | $16,640.13 |
- 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
- $14,613.64 / $18,892.66 / $29,604.56
| Facility | | $14,613.64 | $18,892.66 | $29,604.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,913.65 / $23,873.72 / $31,506.88
| Facility | | $17,913.65 | $23,873.72 | $31,506.88 |