- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,570.60 / $30,943.80 / $38,109.80
| Facility | | $25,570.60 | $30,943.80 | $38,109.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,027.94 / $27,331.50 / $27,804.98
| Facility | | $25,027.94 | $27,331.50 | $27,804.98 |
- 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
- $24,418.80 / $31,568.88 / $49,468.02
| Facility | | $24,418.80 | $31,568.88 | $49,468.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,932.98 / $39,892.01 / $52,646.72
| Facility | | $29,932.98 | $39,892.01 | $52,646.72 |