- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $30,199.52 / $43,651.58
| Facility | | $19,952.62 | $30,199.52 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $25,118.86 / $38,018.94
| Facility | | $16,218.10 | $25,118.86 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $29,512.09 / $44,668.36
| Facility | | $18,620.87 | $29,512.09 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $25,703.96 / $40,738.03
| Facility | | $16,218.10 | $25,703.96 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $18,620.87 / $30,902.95
| Facility | | $11,748.98 | $18,620.87 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $29,512.09 / $42,657.95
| Facility | | $10,000.00 | $29,512.09 | $42,657.95 |