- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,947.70 / $20,509.00 / $25,258.50
| Facility | | $16,947.70 | $20,509.00 | $25,258.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,588.07 / $18,114.83 / $18,428.64
| Facility | | $16,588.07 | $18,114.83 | $18,428.64 |
- 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
- $16,184.34 / $20,923.28 / $32,786.51
| Facility | | $16,184.34 | $20,923.28 | $32,786.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,839.04 / $26,439.71 / $34,893.30
| Facility | | $19,839.04 | $26,439.71 | $34,893.30 |