- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,089.20 / $19,089.20 / $22,624.50
| Facility | | $19,089.20 | $19,089.20 | $22,624.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,015.72 / $22,804.32 / $34,113.87
| Facility | | $14,015.72 | $22,804.32 | $34,113.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,612.64 / $19,323.95 / $32,877.46
| Facility | | $15,612.64 | $19,323.95 | $32,877.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,968.36 / $22,412.27 / $36,685.66
| Facility | | $13,968.36 | $22,412.27 | $36,685.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.18 / $13,012.49 / $18,719.84
| Facility | | $206.18 | $13,012.49 | $18,719.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,895.31 / $22,142.37 / $26,022.84
| Facility | | $15,895.31 | $22,142.37 | $26,022.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,345.51 / $23,618.08 / $29,772.51
| Facility | | $14,345.51 | $23,618.08 | $29,772.51 |