- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,025.80 / $19,393.40 / $23,884.50
| Facility | | $16,025.80 | $19,393.40 | $23,884.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,685.74 / $17,129.45 / $17,426.20
| Facility | | $15,685.74 | $17,129.45 | $17,426.20 |
- 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
- $15,303.98 / $19,785.14 / $31,003.06
| Facility | | $15,303.98 | $19,785.14 | $31,003.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,759.88 / $25,001.50 / $32,995.24
| Facility | | $18,759.88 | $25,001.50 | $32,995.24 |