- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,531.20 / $21,215.10 / $26,128.10
| Facility | | $17,531.20 | $21,215.10 | $26,128.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,159.18 / $18,738.52 / $19,063.14
| Facility | | $17,159.18 | $18,738.52 | $19,063.14 |
- 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
- $16,741.57 / $21,643.67 / $33,915.35
| Facility | | $16,741.57 | $21,643.67 | $33,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,522.09 / $27,350.03 / $36,094.67
| Facility | | $20,522.09 | $27,350.03 | $36,094.67 |