- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,165.20 / $19,562.09 / $24,092.30
| Facility | | $16,165.20 | $19,562.09 | $24,092.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,822.17 / $17,278.43 / $17,577.75
| Facility | | $15,822.17 | $17,278.43 | $17,577.75 |
- 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
- $15,437.09 / $19,957.23 / $31,272.72
| Facility | | $15,437.09 | $19,957.23 | $31,272.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,923.04 / $25,218.96 / $33,282.23
| Facility | | $18,923.04 | $25,218.96 | $33,282.23 |