- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,339.00 / $20,982.40 / $25,841.60
| Facility | | $17,339.00 | $20,982.40 | $25,841.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,971.00 / $18,533.02 / $18,854.08
| Facility | | $16,971.00 | $18,533.02 | $18,854.08 |
- 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
- $16,557.97 / $21,406.31 / $33,543.41
| Facility | | $16,557.97 | $21,406.31 | $33,543.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,297.04 / $27,050.09 / $35,698.83
| Facility | | $20,297.04 | $27,050.09 | $35,698.83 |