- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,882.30 / $20,429.90 / $25,161.10
| Facility | | $16,882.30 | $20,429.90 | $25,161.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,524.09 / $18,044.96 / $18,357.56
| Facility | | $16,524.09 | $18,044.96 | $18,357.56 |
- 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
- $16,121.92 / $20,842.58 / $32,660.05
| Facility | | $16,121.92 | $20,842.58 | $32,660.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,762.52 / $26,337.73 / $34,758.71
| Facility | | $19,762.52 | $26,337.73 | $34,758.71 |