- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,476.70 / $19,939.00 / $24,556.50
| Facility | | $16,476.70 | $19,939.00 | $24,556.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,127.03 / $17,611.34 / $17,916.43
| Facility | | $16,127.03 | $17,611.34 | $17,916.43 |
- 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
- $15,734.52 / $20,341.75 / $31,875.26
| Facility | | $15,734.52 | $20,341.75 | $31,875.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,287.64 / $25,704.86 / $33,923.49
| Facility | | $19,287.64 | $25,704.86 | $33,923.49 |