- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,234.20 / $20,855.59 / $25,685.40
| Facility | | $17,234.20 | $20,855.59 | $25,685.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,868.46 / $18,421.02 / $18,740.14
| Facility | | $16,868.46 | $18,421.02 | $18,740.14 |
- 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
- $16,457.90 / $21,276.95 / $33,340.69
| Facility | | $16,457.90 | $21,276.95 | $33,340.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,174.38 / $26,886.62 / $35,483.10
| Facility | | $20,174.38 | $26,886.62 | $35,483.10 |