- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $25,118.86 / $25,703.96
| Facility | | $20,892.96 | $25,118.86 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $26,915.35 / $38,904.51
| Facility | | $15,488.17 | $26,915.35 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $21,877.62 / $38,904.51
| Facility | | $16,218.10 | $21,877.62 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $20,892.96 / $26,915.35
| Facility | | $18,197.01 | $20,892.96 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $24,547.09 / $40,738.03
| Facility | | $15,488.17 | $24,547.09 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $15,848.93 / $20,892.96
| Facility | | $177.83 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $28,840.32 / $29,512.09
| Facility | | $22,908.68 | $28,840.32 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $26,302.68 / $36,307.81
| Facility | | $15,848.93 | $26,302.68 | $36,307.81 |