- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,681.70 / $19,681.70 / $23,326.70
| Facility | | $19,681.70 | $19,681.70 | $23,326.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,718.23 / $22,320.29 / $33,389.80
| Facility | | $13,718.23 | $22,320.29 | $33,389.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,097.23 / $19,923.73 / $33,897.92
| Facility | | $16,097.23 | $19,923.73 | $33,897.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,401.92 / $23,107.91 / $37,824.32
| Facility | | $14,401.92 | $23,107.91 | $37,824.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.80 / $12,736.29 / $19,300.87
| Facility | | $201.80 | $12,736.29 | $19,300.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,388.68 / $22,829.63 / $26,830.54
| Facility | | $16,388.68 | $22,829.63 | $26,830.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,790.77 / $24,351.14 / $30,696.60
| Facility | | $14,790.77 | $24,351.14 | $30,696.60 |