- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,102.50 / $25,536.80 / $31,450.60
| Facility | | $21,102.50 | $25,536.80 | $31,450.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,654.64 / $22,555.68 / $22,946.43
| Facility | | $20,654.64 | $22,555.68 | $22,946.43 |
- 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
- $20,151.93 / $26,052.63 / $40,824.12
| Facility | | $20,151.93 | $26,052.63 | $40,824.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,702.59 / $32,921.41 / $43,447.40
| Facility | | $24,702.59 | $32,921.41 | $43,447.40 |