- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,586.20 / $24,912.10 / $30,681.30
| Facility | | $20,586.20 | $24,912.10 | $30,681.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,149.37 / $22,003.91 / $22,385.10
| Facility | | $20,149.37 | $22,003.91 | $22,385.10 |
- 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
- $19,658.97 / $25,415.32 / $39,825.48
| Facility | | $19,658.97 | $25,415.32 | $39,825.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,098.30 / $32,116.08 / $42,384.57
| Facility | | $24,098.30 | $32,116.08 | $42,384.57 |