- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,395.70 / $21,051.10 / $25,926.10
| Facility | | $17,395.70 | $21,051.10 | $25,926.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,026.53 / $18,593.64 / $18,915.75
| Facility | | $17,026.53 | $18,593.64 | $18,915.75 |
- 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
- $16,612.13 / $21,476.33 / $33,653.12
| Facility | | $16,612.13 | $21,476.33 | $33,653.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,363.43 / $27,138.57 / $35,815.60
| Facility | | $20,363.43 | $27,138.57 | $35,815.60 |