- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $19,952.62 / $23,442.29
| Facility | | $10,964.78 | $19,952.62 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $16,982.44 / $27,542.29
| Facility | | $11,481.54 | $16,982.44 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,952.62 / $28,183.83
| Facility | | $10,000.00 | $19,952.62 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $15,488.17 / $33,113.11
| Facility | | $7,079.46 | $15,488.17 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $15,488.17 / $33,113.11
| Facility | | $6,309.57 | $15,488.17 | $33,113.11 |