- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,948.00 / $21,948.00 / $26,012.70
| Facility | | $21,948.00 | $21,948.00 | $26,012.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,269.96 / $24,845.04 / $37,166.67
| Facility | | $15,269.96 | $24,845.04 | $37,166.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,950.73 / $22,217.82 / $37,801.05
| Facility | | $17,950.73 | $22,217.82 | $37,801.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,060.21 / $25,768.64 / $42,179.55
| Facility | | $16,060.21 | $25,768.64 | $42,179.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.63 / $14,176.95 / $21,523.25
| Facility | | $224.63 | $14,176.95 | $21,523.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,275.73 / $25,458.32 / $29,919.91
| Facility | | $18,275.73 | $25,458.32 | $29,919.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,493.84 / $27,155.02 / $34,231.11
| Facility | | $16,493.84 | $27,155.02 | $34,231.11 |