- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,432.90 / $22,306.30 / $27,472.00
| Facility | | $18,432.90 | $22,306.30 | $27,472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,041.75 / $19,702.31 / $20,043.63
| Facility | | $18,041.75 | $19,702.31 | $20,043.63 |
- 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
- $17,602.65 / $22,756.89 / $35,659.75
| Facility | | $17,602.65 | $22,756.89 | $35,659.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,577.63 / $28,756.75 / $37,951.16
| Facility | | $21,577.63 | $28,756.75 | $37,951.16 |