- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,791.08 / $19,952.62
| Facility | | $7,762.47 | $14,791.08 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,302.69 / $19,952.62
| Facility | | $8,511.38 | $12,302.69 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $15,848.93 / $21,379.62
| Facility | | $7,585.78 | $15,848.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $11,481.54 / $23,442.29
| Facility | | $5,248.07 | $11,481.54 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $11,481.54 / $22,387.21
| Facility | | $4,897.79 | $11,481.54 | $22,387.21 |