- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,054.61 / $24,547.09
| Facility | | $13,489.63 | $19,054.61 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $16,595.87 / $22,908.68
| Facility | | $11,481.54 | $16,595.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $19,952.62 / $28,183.83
| Facility | | $10,471.29 | $19,952.62 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,498.45 / $25,118.86
| Facility | | $11,748.98 | $19,498.45 | $25,118.86 |
- 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 |