- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,127.50 / $20,726.50 / $25,526.40
| Facility | | $17,127.50 | $20,726.50 | $25,526.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,764.02 / $18,306.97 / $18,624.11
| Facility | | $16,764.02 | $18,306.97 | $18,624.11 |
- 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
- $16,356.01 / $21,145.22 / $33,134.26
| Facility | | $16,356.01 | $21,145.22 | $33,134.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,049.47 / $26,720.15 / $35,263.41
| Facility | | $20,049.47 | $26,720.15 | $35,263.41 |