- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $16,595.87 / $26,915.35
| Facility | | $12,589.25 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,882.50 / $14,125.38
| Facility | | $12,589.25 | $12,882.50 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $21,379.62
| Facility | | $4,677.35 | $12,589.25 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $15,848.93 / $26,915.35
| Facility | | $11,220.18 | $15,848.93 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $23,442.29
| Facility | | $10,000.00 | $15,135.61 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $14,791.08 / $21,877.62
| Facility | | $8,709.64 | $14,791.08 | $21,877.62 |