- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,218.10 / $22,387.21
| Facility | | $6,165.95 | $16,218.10 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $17,378.01
| Facility | | $14,454.40 | $14,454.40 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $19,498.45 / $30,902.95
| Facility | | $12,302.69 | $19,498.45 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $14,454.40 / $30,199.52
| Facility | | $10,471.29 | $14,454.40 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,803.84 / $26,302.68
| Facility | | $9,120.11 | $13,803.84 | $26,302.68 |