- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,971.50 / $26,588.40 / $32,745.80
| Facility | | $21,971.50 | $26,588.40 | $32,745.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,505.21 / $23,484.54 / $23,891.38
| Facility | | $21,505.21 | $23,484.54 | $23,891.38 |
- 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
- $20,981.81 / $27,125.50 / $42,505.30
| Facility | | $20,981.81 | $27,125.50 | $42,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,719.86 / $34,277.14 / $45,236.60
| Facility | | $25,719.86 | $34,277.14 | $45,236.60 |