- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,271.60 / $25,741.50 / $31,702.80
| Facility | | $21,271.60 | $25,741.50 | $31,702.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,820.24 / $22,736.52 / $23,130.40
| Facility | | $20,820.24 | $22,736.52 | $23,130.40 |
- 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
- $20,313.50 / $26,261.51 / $41,151.44
| Facility | | $20,313.50 | $26,261.51 | $41,151.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,900.64 / $33,185.36 / $43,795.74
| Facility | | $24,900.64 | $33,185.36 | $43,795.74 |