- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $23,988.33
| Facility | | $11,220.18 | $16,982.44 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $14,791.08 / $25,118.86
| Facility | | $5,495.41 | $14,791.08 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $13,803.84 / $23,988.33
| Facility | | $10,000.00 | $13,803.84 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $15,488.17 / $22,387.21
| Facility | | $12,589.25 | $15,488.17 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $15,135.61 / $22,387.21
| Facility | | $7,943.28 | $15,135.61 | $22,387.21 |