- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,515.60 / $27,246.80 / $33,556.69
| Facility | | $22,515.60 | $27,246.80 | $33,556.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,037.76 / $24,066.11 / $24,483.02
| Facility | | $22,037.76 | $24,066.11 | $24,483.02 |
- 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
- $21,501.40 / $27,797.23 / $43,557.89
| Facility | | $21,501.40 | $27,797.23 | $43,557.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,356.78 / $35,125.97 / $46,356.82
| Facility | | $26,356.78 | $35,125.97 | $46,356.82 |