- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,364.90 / $21,013.80 / $25,880.30
| Facility | | $17,364.90 | $21,013.80 | $25,880.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,996.41 / $18,560.75 / $18,882.30
| Facility | | $16,996.41 | $18,560.75 | $18,882.30 |
- 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
- $16,582.75 / $21,438.36 / $33,593.62
| Facility | | $16,582.75 | $21,438.36 | $33,593.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,327.41 / $27,090.58 / $35,752.26
| Facility | | $20,327.41 | $27,090.58 | $35,752.26 |