- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,743.30 / $15,743.30 / $18,658.90
| Facility | | $15,743.30 | $15,743.30 | $18,658.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.58 / $19,144.84 / $28,639.53
| Facility | | $11,766.58 | $19,144.84 | $28,639.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,876.06 / $15,936.85 / $27,114.71
| Facility | | $12,876.06 | $15,936.85 | $27,114.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,519.99 / $18,483.86 / $30,255.41
| Facility | | $11,519.99 | $18,483.86 | $30,255.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.09 / $10,924.34 / $15,608.25
| Facility | | $173.09 | $10,924.34 | $15,608.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,109.19 / $18,261.27 / $21,461.57
| Facility | | $13,109.19 | $18,261.27 | $21,461.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,831.04 / $19,478.31 / $24,553.99
| Facility | | $11,831.04 | $19,478.31 | $24,553.99 |