- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,657.59 / $16,657.59 / $19,742.50
| Facility | | $16,657.59 | $16,657.59 | $19,742.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,237.33 / $19,910.79 / $29,785.32
| Facility | | $12,237.33 | $19,910.79 | $29,785.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,623.86 / $16,862.41 / $28,689.43
| Facility | | $13,623.86 | $16,862.41 | $28,689.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,189.03 / $19,557.33 / $32,012.53
| Facility | | $12,189.03 | $19,557.33 | $32,012.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.02 / $11,361.39 / $16,335.25
| Facility | | $180.02 | $11,361.39 | $16,335.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,870.52 / $19,321.81 / $22,707.97
| Facility | | $13,870.52 | $19,321.81 | $22,707.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,518.14 / $20,609.53 / $25,980.00
| Facility | | $12,518.14 | $20,609.53 | $25,980.00 |