- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,895.20 / $17,895.20 / $21,209.40
| Facility | | $17,895.20 | $17,895.20 | $21,209.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,801.79 / $20,829.20 / $31,159.22
| Facility | | $12,801.79 | $20,829.20 | $31,159.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,636.08 / $18,115.25 / $30,821.00
| Facility | | $14,636.08 | $18,115.25 | $30,821.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,094.65 / $21,010.40 / $34,391.00
| Facility | | $13,094.65 | $21,010.40 | $34,391.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.32 / $11,885.45 / $17,548.93
| Facility | | $188.32 | $11,885.45 | $17,548.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,901.07 / $20,757.38 / $24,395.13
| Facility | | $14,901.07 | $20,757.38 | $24,395.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,491.43 / $21,976.92 / $27,910.26
| Facility | | $12,491.43 | $21,976.92 | $27,910.26 |