- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,374.10 / $18,604.70 / $22,913.20
| Facility | | $15,374.10 | $18,604.70 | $22,913.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,047.81 / $16,432.81 / $16,717.48
| Facility | | $15,047.81 | $16,432.81 | $16,717.48 |
- 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
- $14,681.57 / $18,980.49 / $29,742.18
| Facility | | $14,681.57 | $18,980.49 | $29,742.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,996.91 / $23,984.70 / $31,653.35
| Facility | | $17,996.91 | $23,984.70 | $31,653.35 |