- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,481.00 / $27,204.90 / $33,505.10
| Facility | | $22,481.00 | $27,204.90 | $33,505.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,003.89 / $24,029.12 / $24,445.39
| Facility | | $22,003.89 | $24,029.12 | $24,445.39 |
- 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
- $21,468.35 / $27,754.50 / $43,490.94
| Facility | | $21,468.35 | $27,754.50 | $43,490.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,316.27 / $35,071.98 / $46,285.57
| Facility | | $26,316.27 | $35,071.98 | $46,285.57 |