- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $17,782.79 / $19,498.45
| Facility | | $6,918.31 | $17,782.79 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,488.17 / $21,877.62
| Facility | | $15,135.61 | $15,488.17 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $21,877.62 / $34,673.69
| Facility | | $14,125.38 | $21,877.62 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,595.87 / $34,673.69
| Facility | | $12,022.64 | $16,595.87 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $15,488.17 / $29,512.09
| Facility | | $10,232.93 | $15,488.17 | $29,512.09 |