- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,677.20 / $17,677.20 / $20,950.90
| Facility | | $17,677.20 | $17,677.20 | $20,950.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,402.96 / $20,180.28 / $30,188.47
| Facility | | $12,402.96 | $20,180.28 | $30,188.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,457.74 / $17,894.52 / $30,445.45
| Facility | | $14,457.74 | $17,894.52 | $30,445.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,935.10 / $20,754.39 / $33,971.94
| Facility | | $12,935.10 | $20,754.39 | $33,971.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.45 / $11,515.17 / $17,335.09
| Facility | | $182.45 | $11,515.17 | $17,335.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,719.51 / $20,504.46 / $24,097.88
| Facility | | $14,719.51 | $20,504.46 | $24,097.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,284.35 / $21,871.00 / $27,570.18
| Facility | | $13,284.35 | $21,871.00 | $27,570.18 |