- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,817.20 / $25,817.20 / $30,598.50
| Facility | | $25,817.20 | $25,817.20 | $30,598.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,843.83 / $29,032.87 / $43,431.41
| Facility | | $17,843.83 | $29,032.87 | $43,431.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,115.32 / $26,134.67 / $44,465.12
| Facility | | $21,115.32 | $26,134.67 | $44,465.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,891.50 / $30,311.48 / $49,615.52
| Facility | | $18,891.50 | $30,311.48 | $49,615.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.49 / $16,566.59 / $25,317.65
| Facility | | $262.49 | $16,566.59 | $25,317.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,497.62 / $29,946.45 / $35,194.58
| Facility | | $21,497.62 | $29,946.45 | $35,194.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,401.59 / $31,942.27 / $40,265.83
| Facility | | $19,401.59 | $31,942.27 | $40,265.83 |