- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,212.70 / $23,212.70 / $27,511.60
| Facility | | $23,212.70 | $23,212.70 | $27,511.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,099.57 / $27,821.91 / $41,619.89
| Facility | | $17,099.57 | $27,821.91 | $41,619.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,985.09 / $23,498.07 / $39,979.24
| Facility | | $18,985.09 | $23,498.07 | $39,979.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,985.64 / $27,253.49 / $44,610.04
| Facility | | $16,985.64 | $27,253.49 | $44,610.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.54 / $15,875.60 / $22,763.47
| Facility | | $251.54 | $15,875.60 | $22,763.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,328.82 / $26,925.29 / $31,643.97
| Facility | | $19,328.82 | $26,925.29 | $31,643.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,444.25 / $28,719.76 / $36,203.58
| Facility | | $17,444.25 | $28,719.76 | $36,203.58 |