- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,364.70 / $22,169.70 / $29,750.00
| Facility | | $13,364.70 | $22,169.70 | $29,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,916.87 / $13,093.16 / $24,652.67
| Facility | | $11,916.87 | $13,093.16 | $24,652.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,459.66 / $18,343.32 / $29,350.02
| Facility | | $10,459.66 | $18,343.32 | $29,350.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,974.18 / $17,850.00 / $40,937.19
| Facility | | $10,974.18 | $17,850.00 | $40,937.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,222.02 / $17,043.18 / $24,909.08
| Facility | | $10,222.02 | $17,043.18 | $24,909.08 |