- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,869.59 / $21,624.60 / $26,632.50
| Facility | | $17,869.59 | $21,624.60 | $26,632.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,490.39 / $19,100.20 / $19,431.08
| Facility | | $17,490.39 | $19,100.20 | $19,431.08 |
- 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
- $17,064.70 / $22,061.43 / $34,569.96
| Facility | | $17,064.70 | $22,061.43 | $34,569.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,918.20 / $27,877.92 / $36,791.35
| Facility | | $20,918.20 | $27,877.92 | $36,791.35 |