- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $11,748.98 / $16,595.87
| Facility | | $4,897.79 | $11,748.98 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $18,620.87
| Facility | | $12,302.69 | $12,302.69 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $24,547.09
| Facility | | $10,000.00 | $15,135.61 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $11,481.54 / $24,547.09
| Facility | | $8,317.64 | $11,481.54 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,964.78 / $20,892.96
| Facility | | $7,244.36 | $10,964.78 | $20,892.96 |