- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,611.30 / $20,101.80 / $24,757.10
| Facility | | $16,611.30 | $20,101.80 | $24,757.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,258.75 / $17,755.20 / $18,062.78
| Facility | | $16,258.75 | $17,755.20 | $18,062.78 |
- 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
- $15,863.04 / $20,507.90 / $32,135.62
| Facility | | $15,863.04 | $20,507.90 | $32,135.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,445.18 / $25,914.82 / $34,200.58
| Facility | | $19,445.18 | $25,914.82 | $34,200.58 |