- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,658.40 / $20,158.80 / $24,827.30
| Facility | | $16,658.40 | $20,158.80 | $24,827.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,304.86 / $17,805.55 / $18,114.00
| Facility | | $16,304.86 | $17,805.55 | $18,114.00 |
- 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
- $15,908.02 / $20,566.06 / $32,226.74
| Facility | | $15,908.02 | $20,566.06 | $32,226.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,500.32 / $25,988.30 / $34,297.56
| Facility | | $19,500.32 | $25,988.30 | $34,297.56 |