- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,488.17 / $42,657.95
| Facility | | $10,000.00 | $15,488.17 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $17,782.79 / $27,542.29
| Facility | | $12,302.69 | $17,782.79 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $20,892.96 / $28,183.83
| Facility | | $13,489.63 | $20,892.96 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61,659.50 / $61,659.50 / $61,659.50
| Facility | | $61,659.50 | $61,659.50 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $19,952.62 / $31,622.78
| Facility | | $3,801.89 | $19,952.62 | $31,622.78 |