- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,671.10 / $18,964.09 / $23,355.90
| Facility | | $15,671.10 | $18,964.09 | $23,355.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,338.55 / $16,750.31 / $17,040.48
| Facility | | $15,338.55 | $16,750.31 | $17,040.48 |
- 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
- $14,965.24 / $19,347.21 / $30,316.83
| Facility | | $14,965.24 | $19,347.21 | $30,316.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,344.64 / $24,448.11 / $32,264.92
| Facility | | $18,344.64 | $24,448.11 | $32,264.92 |