- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,875.70 / $19,875.70 / $23,556.70
| Facility | | $19,875.70 | $19,875.70 | $23,556.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,601.98 / $23,758.20 / $35,540.82
| Facility | | $14,601.98 | $23,758.20 | $35,540.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,255.89 / $20,120.11 / $34,232.03
| Facility | | $16,255.89 | $20,120.11 | $34,232.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,543.87 / $23,335.67 / $38,197.12
| Facility | | $14,543.87 | $23,335.67 | $38,197.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.80 / $13,556.78 / $19,491.11
| Facility | | $214.80 | $13,556.78 | $19,491.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,550.21 / $23,054.65 / $27,095.00
| Facility | | $16,550.21 | $23,054.65 | $27,095.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,936.56 / $24,591.15 / $30,999.15
| Facility | | $14,936.56 | $24,591.15 | $30,999.15 |