- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,045.00 / $24,257.10 / $29,874.70
| Facility | | $20,045.00 | $24,257.10 | $29,874.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,619.65 / $21,425.43 / $21,796.60
| Facility | | $19,619.65 | $21,425.43 | $21,796.60 |
- 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
- $19,142.14 / $24,747.15 / $38,778.46
| Facility | | $19,142.14 | $24,747.15 | $38,778.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,464.76 / $31,271.74 / $41,270.28
| Facility | | $23,464.76 | $31,271.74 | $41,270.28 |