- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $16,218.10 / $22,908.68
| Facility | | $6,918.31 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,379.62 / $33,884.42
| Facility | | $13,803.84 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $33,884.42
| Facility | | $11,748.98 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,454.40 / $29,512.09
| Facility | | $10,232.93 | $14,454.40 | $29,512.09 |