- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,588.40 / $17,588.40 / $20,845.80
| Facility | | $17,588.40 | $17,588.40 | $20,845.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,284.53 / $21,614.64 / $32,334.18
| Facility | | $13,284.53 | $21,614.64 | $32,334.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,385.18 / $17,804.70 / $30,292.64
| Facility | | $14,385.18 | $17,804.70 | $30,292.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,870.17 / $20,650.22 / $33,801.44
| Facility | | $12,870.17 | $20,650.22 | $33,801.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.42 / $12,333.63 / $17,621.80
| Facility | | $195.42 | $12,333.63 | $17,621.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,645.63 / $20,401.54 / $23,976.93
| Facility | | $14,645.63 | $20,401.54 | $23,976.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,217.67 / $21,761.23 / $27,431.80
| Facility | | $13,217.67 | $21,761.23 | $27,431.80 |