- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,542.50 / $22,438.90 / $27,635.30
| Facility | | $18,542.50 | $22,438.90 | $27,635.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,149.02 / $19,819.45 / $20,162.79
| Facility | | $18,149.02 | $19,819.45 | $20,162.79 |
- 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
- $17,707.30 / $22,892.19 / $35,871.75
| Facility | | $17,707.30 | $22,892.19 | $35,871.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,705.91 / $28,927.71 / $38,176.79
| Facility | | $21,705.91 | $28,927.71 | $38,176.79 |