- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $17,782.79 / $27,542.29
| Facility | | $12,589.25 | $17,782.79 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $15,135.61 / $23,442.29
| Facility | | $10,471.29 | $15,135.61 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,135.61 / $26,915.35
| Facility | | $9,549.93 | $15,135.61 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $14,454.40 / $25,118.86
| Facility | | $7,585.78 | $14,454.40 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,748.98 / $19,952.62
| Facility | | $7,413.10 | $11,748.98 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $19,054.61 / $26,915.35
| Facility | | $7,413.10 | $19,054.61 | $26,915.35 |