- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,930.40 / $25,328.50 / $31,194.20
| Facility | | $20,930.40 | $25,328.50 | $31,194.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,486.22 / $22,371.76 / $22,759.32
| Facility | | $20,486.22 | $22,371.76 | $22,759.32 |
- 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
- $19,987.61 / $25,840.20 / $40,491.25
| Facility | | $19,987.61 | $25,840.20 | $40,491.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,501.16 / $32,652.97 / $43,093.12
| Facility | | $24,501.16 | $32,652.97 | $43,093.12 |