- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,350.30 / $22,206.20 / $27,348.80
| Facility | | $18,350.30 | $22,206.20 | $27,348.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,960.84 / $19,613.95 / $19,953.73
| Facility | | $17,960.84 | $19,613.95 | $19,953.73 |
- 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
- $17,523.70 / $22,654.83 / $35,499.81
| Facility | | $17,523.70 | $22,654.83 | $35,499.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,480.85 / $28,627.77 / $37,780.94
| Facility | | $21,480.85 | $28,627.77 | $37,780.94 |