- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,083.30 / $23,083.30 / $27,358.30
| Facility | | $23,083.30 | $23,083.30 | $27,358.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,727.98 / $27,217.32 / $40,715.44
| Facility | | $16,727.98 | $27,217.32 | $40,715.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,879.32 / $23,367.15 / $39,756.50
| Facility | | $18,879.32 | $23,367.15 | $39,756.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,891.00 / $27,101.65 / $44,361.50
| Facility | | $16,891.00 | $27,101.65 | $44,361.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.08 / $15,530.61 / $22,636.65
| Facility | | $246.08 | $15,530.61 | $22,636.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,221.13 / $26,775.28 / $31,467.67
| Facility | | $19,221.13 | $26,775.28 | $31,467.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,347.07 / $28,559.75 / $36,001.89
| Facility | | $17,347.07 | $28,559.75 | $36,001.89 |