- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,383.70 / $18,616.30 / $22,927.50
| Facility | | $15,383.70 | $18,616.30 | $22,927.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,057.22 / $16,443.08 / $16,727.93
| Facility | | $15,057.22 | $16,443.08 | $16,727.93 |
- 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
- $15,217.25 / $18,973.16 / $29,760.78
| Facility | | $15,217.25 | $18,973.16 | $29,760.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,770.40 / $20,005.34 / $29,760.78
| Facility | | $14,770.40 | $20,005.34 | $29,760.78 |