- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,042.70 / $21,042.70 / $24,939.70
| Facility | | $21,042.70 | $21,042.70 | $24,939.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,615.40 / $25,407.09 / $38,007.44
| Facility | | $15,615.40 | $25,407.09 | $38,007.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,210.31 / $21,301.40 / $36,241.87
| Facility | | $17,210.31 | $21,301.40 | $36,241.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,397.77 / $24,705.76 / $40,439.76
| Facility | | $15,397.77 | $24,705.76 | $40,439.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.71 / $14,497.66 / $20,713.66
| Facility | | $229.71 | $14,497.66 | $20,713.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,521.91 / $24,408.24 / $28,685.80
| Facility | | $17,521.91 | $24,408.24 | $28,685.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,813.52 / $26,034.96 / $32,819.18
| Facility | | $15,813.52 | $26,034.96 | $32,819.18 |