- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,244.80 / $20,868.40 / $25,701.20
| Facility | | $17,244.80 | $20,868.40 | $25,701.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,878.81 / $18,432.32 / $18,751.64
| Facility | | $16,878.81 | $18,432.32 | $18,751.64 |
- 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
- $16,468.00 / $21,290.01 / $33,361.16
| Facility | | $16,468.00 | $21,290.01 | $33,361.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,468.00 / $23,195.00 / $31,473.98
| Facility | | $16,468.00 | $23,195.00 | $31,473.98 |