- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $18,620.87 / $26,302.68
| Facility | | $7,762.47 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $19,952.62 / $26,302.68
| Facility | | $18,197.01 | $19,952.62 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $24,547.09 / $38,904.51
| Facility | | $15,848.93 | $24,547.09 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,620.87 / $38,904.51
| Facility | | $13,489.63 | $18,620.87 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,378.01 / $33,113.11
| Facility | | $11,481.54 | $17,378.01 | $33,113.11 |