- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,012.50 / $17,012.50 / $20,163.20
| Facility | | $17,012.50 | $17,012.50 | $20,163.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,756.77 / $19,128.89 / $28,615.66
| Facility | | $11,756.77 | $19,128.89 | $28,615.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,914.12 / $17,221.66 / $29,300.67
| Facility | | $13,914.12 | $17,221.66 | $29,300.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,448.72 / $19,974.00 / $32,694.57
| Facility | | $12,448.72 | $19,974.00 | $32,694.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.95 / $10,915.23 / $16,683.28
| Facility | | $172.95 | $10,915.23 | $16,683.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,166.04 / $19,733.47 / $23,191.77
| Facility | | $14,166.04 | $19,733.47 | $23,191.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,784.84 / $21,048.63 / $26,533.51
| Facility | | $12,784.84 | $21,048.63 | $26,533.51 |