- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,578.59 / $24,902.80 / $30,669.80
| Facility | | $20,578.59 | $24,902.80 | $30,669.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,141.84 / $21,995.69 / $22,376.74
| Facility | | $20,141.84 | $21,995.69 | $22,376.74 |
- 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
- $19,651.63 / $25,405.83 / $39,810.60
| Facility | | $19,651.63 | $25,405.83 | $39,810.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,089.30 / $32,104.08 / $42,368.73
| Facility | | $24,089.30 | $32,104.08 | $42,368.73 |