- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,702.59 / $20,212.30 / $24,893.20
| Facility | | $16,702.59 | $20,212.30 | $24,893.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,348.14 / $17,852.81 / $18,162.09
| Facility | | $16,348.14 | $17,852.81 | $18,162.09 |
- 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
- $15,950.25 / $20,620.65 / $32,312.29
| Facility | | $15,950.25 | $20,620.65 | $32,312.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,552.09 / $26,057.29 / $34,388.60
| Facility | | $19,552.09 | $26,057.29 | $34,388.60 |