- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,793.80 / $30,003.80 / $36,952.19
| Facility | | $24,793.80 | $30,003.80 | $36,952.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,267.69 / $26,501.28 / $26,960.38
| Facility | | $24,267.69 | $26,501.28 | $26,960.38 |
- 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
- $23,677.06 / $30,609.95 / $47,965.38
| Facility | | $23,677.06 | $30,609.95 | $47,965.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,023.74 / $38,680.26 / $51,047.53
| Facility | | $29,023.74 | $38,680.26 | $51,047.53 |