- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,244.00 / $19,657.40 / $24,209.80
| Facility | | $16,244.00 | $19,657.40 | $24,209.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,899.33 / $17,362.70 / $17,663.48
| Facility | | $15,899.33 | $17,362.70 | $17,663.48 |
- 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
- $15,512.36 / $20,054.55 / $31,425.21
| Facility | | $15,512.36 | $20,054.55 | $31,425.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,068.31 / $21,849.00 / $29,647.54
| Facility | | $16,068.31 | $21,849.00 | $29,647.54 |