- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,475.70 / $24,778.30 / $30,516.50
| Facility | | $20,475.70 | $24,778.30 | $30,516.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,041.16 / $21,885.75 / $22,264.89
| Facility | | $20,041.16 | $21,885.75 | $22,264.89 |
- 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
- $19,553.40 / $25,278.84 / $39,611.61
| Facility | | $19,553.40 | $25,278.84 | $39,611.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,968.89 / $31,943.61 / $42,156.96
| Facility | | $23,968.89 | $31,943.61 | $42,156.96 |