- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,496.10 / $28,433.40 / $35,018.10
| Facility | | $23,496.10 | $28,433.40 | $35,018.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,997.48 / $25,114.16 / $25,549.22
| Facility | | $22,997.48 | $25,114.16 | $25,549.22 |
- 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
- $22,437.76 / $29,007.77 / $45,454.79
| Facility | | $22,437.76 | $29,007.77 | $45,454.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,504.58 / $36,655.67 / $48,375.61
| Facility | | $27,504.58 | $36,655.67 | $48,375.61 |