- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,808.50 / $23,971.00 / $29,522.20
| Facility | | $19,808.50 | $23,971.00 | $29,522.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,388.18 / $21,172.67 / $21,539.45
| Facility | | $19,388.18 | $21,172.67 | $21,539.45 |
- 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
- $18,916.31 / $24,455.20 / $38,320.98
| Facility | | $18,916.31 | $24,455.20 | $38,320.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,187.93 / $30,902.82 / $40,783.40
| Facility | | $23,187.93 | $30,902.82 | $40,783.40 |