- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $19,498.45 / $24,547.09
| Facility | | $13,803.84 | $19,498.45 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,982.44 / $23,442.29
| Facility | | $11,748.98 | $16,982.44 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $20,417.38 / $28,183.83
| Facility | | $10,715.19 | $20,417.38 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $20,417.38 / $24,547.09
| Facility | | $12,022.64 | $20,417.38 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $20,417.38 / $28,183.83
| Facility | | $10,000.00 | $20,417.38 | $28,183.83 |