- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,252.50 / $20,877.70 / $25,712.70
| Facility | | $17,252.50 | $20,877.70 | $25,712.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,886.33 / $18,440.54 / $18,760.00
| Facility | | $16,886.33 | $18,440.54 | $18,760.00 |
- 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
- $16,475.34 / $21,299.50 / $33,376.04
| Facility | | $16,475.34 | $21,299.50 | $33,376.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,195.75 / $26,915.12 / $35,520.69
| Facility | | $20,195.75 | $26,915.12 | $35,520.69 |