- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,000.00 / $14,125.38
| Facility | | $4,168.69 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,471.29 / $10,471.29
| Facility | | $10,000.00 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,182.57 / $20,892.96
| Facility | | $8,511.38 | $13,182.57 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $20,892.96
| Facility | | $7,079.46 | $9,772.37 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,549.93 / $17,782.79
| Facility | | $6,165.95 | $9,549.93 | $17,782.79 |