- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,698.70 / $20,207.70 / $24,887.40
| Facility | | $16,698.70 | $20,207.70 | $24,887.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,344.37 / $17,848.70 / $18,157.91
| Facility | | $16,344.37 | $17,848.70 | $18,157.91 |
- 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
- $15,946.58 / $20,615.90 / $32,304.85
| Facility | | $15,946.58 | $20,615.90 | $32,304.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,547.59 / $26,051.29 / $34,380.68
| Facility | | $19,547.59 | $26,051.29 | $34,380.68 |