- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,375.50 / $21,026.60 / $25,896.10
| Facility | | $17,375.50 | $21,026.60 | $25,896.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,006.77 / $18,572.06 / $18,893.80
| Facility | | $17,006.77 | $18,572.06 | $18,893.80 |
- 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
- $16,592.84 / $21,451.41 / $33,614.08
| Facility | | $16,592.84 | $21,451.41 | $33,614.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,339.80 / $27,107.08 / $35,774.04
| Facility | | $20,339.80 | $27,107.08 | $35,774.04 |