- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,153.90 / $18,153.90 / $21,515.90
| Facility | | $18,153.90 | $18,153.90 | $21,515.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,131.97 / $21,366.42 / $31,962.86
| Facility | | $13,131.97 | $21,366.42 | $31,962.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,847.63 / $18,377.08 / $31,266.48
| Facility | | $14,847.63 | $18,377.08 | $31,266.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,283.92 / $21,314.08 / $34,888.08
| Facility | | $13,283.92 | $21,314.08 | $34,888.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.18 / $12,192.00 / $17,802.58
| Facility | | $193.18 | $12,192.00 | $17,802.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,116.45 / $21,057.41 / $24,747.73
| Facility | | $15,116.45 | $21,057.41 | $24,747.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,642.59 / $22,460.80 / $28,313.67
| Facility | | $13,642.59 | $22,460.80 | $28,313.67 |