- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,004.40 / $20,577.59 / $25,343.00
| Facility | | $17,004.40 | $20,577.59 | $25,343.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,643.58 / $18,175.45 / $18,490.31
| Facility | | $16,643.58 | $18,175.45 | $18,490.31 |
- 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
- $16,238.50 / $20,993.31 / $32,896.23
| Facility | | $16,238.50 | $20,993.31 | $32,896.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,905.43 / $26,528.19 / $35,010.07
| Facility | | $19,905.43 | $26,528.19 | $35,010.07 |