- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,817.00 / $20,350.80 / $25,063.70
| Facility | | $16,817.00 | $20,350.80 | $25,063.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,460.09 / $17,975.09 / $18,286.48
| Facility | | $16,460.09 | $17,975.09 | $18,286.48 |
- 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
- $16,059.49 / $20,761.88 / $32,533.59
| Facility | | $16,059.49 | $20,761.88 | $32,533.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,686.00 / $26,235.75 / $34,624.12
| Facility | | $19,686.00 | $26,235.75 | $34,624.12 |