- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $28,840.32 / $34,673.69
| Facility | | $23,988.33 | $28,840.32 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $26,302.68 / $41,686.94
| Facility | | $25,703.96 | $26,302.68 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $29,512.09 / $46,773.51
| Facility | | $22,908.68 | $29,512.09 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $38,018.94 / $38,018.94
| Facility | | $18,197.01 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $33,113.11 / $48,977.88
| Facility | | $23,988.33 | $33,113.11 | $48,977.88 |