- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,507.20 / $26,026.50 / $32,053.80
| Facility | | $21,507.20 | $26,026.50 | $32,053.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,050.76 / $22,988.26 / $23,386.50
| Facility | | $21,050.76 | $22,988.26 | $23,386.50 |
- 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
- $20,538.41 / $26,552.28 / $41,607.07
| Facility | | $20,538.41 | $26,552.28 | $41,607.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,176.34 / $33,552.79 / $44,280.64
| Facility | | $25,176.34 | $33,552.79 | $44,280.64 |