- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,293.70 / $16,293.70 / $19,311.20
| Facility | | $16,293.70 | $16,293.70 | $19,311.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,867.92 / $19,309.74 / $28,886.19
| Facility | | $11,867.92 | $19,309.74 | $28,886.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,326.22 / $16,494.00 / $28,062.65
| Facility | | $13,326.22 | $16,494.00 | $28,062.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,922.74 / $19,130.06 / $31,313.15
| Facility | | $11,922.74 | $19,130.06 | $31,313.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.58 / $11,018.42 / $15,978.37
| Facility | | $174.58 | $11,018.42 | $15,978.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,567.49 / $18,899.68 / $22,211.87
| Facility | | $13,567.49 | $18,899.68 | $22,211.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,244.66 / $20,159.28 / $25,412.41
| Facility | | $12,244.66 | $20,159.28 | $25,412.41 |