- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,954.60 / $28,988.30 / $35,701.40
| Facility | | $23,954.60 | $28,988.30 | $35,701.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,446.29 / $25,604.27 / $26,047.83
| Facility | | $23,446.29 | $25,604.27 | $26,047.83 |
- 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
- $22,875.64 / $29,573.87 / $46,341.86
| Facility | | $22,875.64 | $29,573.87 | $46,341.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,041.35 / $37,371.01 / $49,319.68
| Facility | | $28,041.35 | $37,371.01 | $49,319.68 |