- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,620.87 / $23,988.33
| Facility | | $13,489.63 | $18,620.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,498.45 / $21,877.62
| Facility | | $10,000.00 | $19,498.45 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $19,498.45 / $27,542.29
| Facility | | $10,232.93 | $19,498.45 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,848.93 / $21,877.62
| Facility | | $10,000.00 | $15,848.93 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $19,498.45 / $27,542.29
| Facility | | $9,772.37 | $19,498.45 | $27,542.29 |