- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,773.50 / $22,773.50 / $26,991.20
| Facility | | $22,773.50 | $22,773.50 | $26,991.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,063.66 / $22,882.33 / $34,230.58
| Facility | | $14,063.66 | $22,882.33 | $34,230.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,625.95 / $23,053.56 / $39,222.96
| Facility | | $18,625.95 | $23,053.56 | $39,222.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,664.32 / $26,737.94 / $43,766.16
| Facility | | $16,664.32 | $26,737.94 | $43,766.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.88 / $13,057.00 / $20,688.32
| Facility | | $206.88 | $13,057.00 | $20,688.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,963.18 / $26,415.95 / $31,045.37
| Facility | | $18,963.18 | $26,415.95 | $31,045.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,114.25 / $28,176.47 / $35,518.74
| Facility | | $17,114.25 | $28,176.47 | $35,518.74 |