- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,210.60 / $18,406.90 / $22,669.60
| Facility | | $15,210.60 | $18,406.90 | $22,669.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,887.86 / $16,258.13 / $16,539.78
| Facility | | $14,887.86 | $16,258.13 | $16,539.78 |
- 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
- $14,525.51 / $18,778.74 / $29,426.03
| Facility | | $14,525.51 | $18,778.74 | $29,426.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,805.62 / $23,729.75 / $31,316.88
| Facility | | $17,805.62 | $23,729.75 | $31,316.88 |