- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,802.80 / $23,964.00 / $29,513.60
| Facility | | $19,802.80 | $23,964.00 | $29,513.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,382.54 / $21,166.50 / $21,533.18
| Facility | | $19,382.54 | $21,166.50 | $21,533.18 |
- 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
- $18,910.80 / $24,448.08 / $38,309.82
| Facility | | $18,910.80 | $24,448.08 | $38,309.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,181.18 / $30,893.82 / $40,771.51
| Facility | | $23,181.18 | $30,893.82 | $40,771.51 |