- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,968.59 / $21,744.40 / $26,780.00
| Facility | | $17,968.59 | $21,744.40 | $26,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,587.30 / $19,206.03 / $19,538.75
| Facility | | $17,587.30 | $19,206.03 | $19,538.75 |
- 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
- $17,159.25 / $22,183.67 / $34,761.51
| Facility | | $17,159.25 | $22,183.67 | $34,761.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,034.11 / $28,032.39 / $36,995.21
| Facility | | $21,034.11 | $28,032.39 | $36,995.21 |