- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,572.59 / $21,265.10 / $26,189.80
| Facility | | $17,572.59 | $21,265.10 | $26,189.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,199.65 / $18,782.70 / $19,108.08
| Facility | | $17,199.65 | $18,782.70 | $19,108.08 |
- 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
- $16,781.04 / $21,694.70 / $33,995.32
| Facility | | $16,781.04 | $21,694.70 | $33,995.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,781.04 / $23,594.00 / $33,995.32
| Facility | | $16,781.04 | $23,594.00 | $33,995.32 |