- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,217.60 / $26,886.20 / $33,112.60
| Facility | | $22,217.60 | $26,886.20 | $33,112.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,746.08 / $23,747.58 / $24,158.97
| Facility | | $21,746.08 | $23,747.58 | $24,158.97 |
- 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
- $21,216.82 / $27,429.32 / $42,981.39
| Facility | | $21,216.82 | $27,429.32 | $42,981.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,007.93 / $34,661.07 / $45,743.27
| Facility | | $26,007.93 | $34,661.07 | $45,743.27 |