- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,981.40 / $20,549.70 / $25,308.60
| Facility | | $16,981.40 | $20,549.70 | $25,308.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,621.00 / $18,150.79 / $18,465.22
| Facility | | $16,621.00 | $18,150.79 | $18,465.22 |
- 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
- $16,216.47 / $20,964.82 / $32,851.60
| Facility | | $16,216.47 | $20,964.82 | $32,851.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,878.41 / $26,492.20 / $34,962.57
| Facility | | $19,878.41 | $26,492.20 | $34,962.57 |