- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $18,197.01 / $23,442.29
| Facility | | $13,182.57 | $18,197.01 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,218.10 / $22,387.21
| Facility | | $10,471.29 | $16,218.10 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,054.61 / $26,915.35
| Facility | | $10,000.00 | $19,054.61 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $19,054.61 / $22,908.68
| Facility | | $10,471.29 | $19,054.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $19,054.61 / $26,915.35
| Facility | | $9,549.93 | $19,054.61 | $26,915.35 |