- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,979.20 / $21,757.20 / $26,795.80
| Facility | | $17,979.20 | $21,757.20 | $26,795.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,597.65 / $19,217.33 / $19,550.25
| Facility | | $17,597.65 | $19,217.33 | $19,550.25 |
- 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
- $17,169.34 / $22,196.72 / $34,781.97
| Facility | | $17,169.34 | $22,196.72 | $34,781.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,046.49 / $28,048.89 / $37,016.98
| Facility | | $21,046.49 | $28,048.89 | $37,016.98 |