- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,062.40 / $19,437.59 / $23,939.00
| Facility | | $16,062.40 | $19,437.59 | $23,939.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,721.50 / $17,168.50 / $17,465.91
| Facility | | $15,721.50 | $17,168.50 | $17,465.91 |
- 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
- $15,338.86 / $19,830.24 / $31,073.73
| Facility | | $15,338.86 | $19,830.24 | $31,073.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,802.64 / $25,058.49 / $33,070.44
| Facility | | $18,802.64 | $25,058.49 | $33,070.44 |