- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,585.60 / $23,585.60 / $27,953.60
| Facility | | $23,585.60 | $23,585.60 | $27,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,867.81 / $29,071.88 / $43,489.76
| Facility | | $17,867.81 | $29,071.88 | $43,489.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,290.11 / $23,875.60 / $40,621.56
| Facility | | $19,290.11 | $23,875.60 | $40,621.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,258.53 / $27,691.36 / $45,326.76
| Facility | | $17,258.53 | $27,691.36 | $45,326.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.83 / $16,588.84 / $23,701.47
| Facility | | $262.83 | $16,588.84 | $23,701.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,639.36 / $27,357.88 / $32,152.37
| Facility | | $19,639.36 | $27,357.88 | $32,152.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,724.52 / $29,181.18 / $36,785.25
| Facility | | $17,724.52 | $29,181.18 | $36,785.25 |