- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $20,892.96 / $23,988.33
| Facility | | $15,488.17 | $20,892.96 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $22,387.21
| Facility | | $19,054.61 | $19,054.61 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $19,952.62 / $26,302.68
| Facility | | $11,481.54 | $19,952.62 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,488.17 / $38,018.94
| Facility | | $10,000.00 | $15,488.17 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,135.61 / $22,387.21
| Facility | | $9,772.37 | $15,135.61 | $22,387.21 |