- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,177.04 / $15,664.80 / $25,462.00
| Facility | | $9,177.04 | $15,664.80 | $25,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $12,468.28 / $17,898.49
| Facility | | $9,687.00 | $12,468.28 | $17,898.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,869.25 / $12,446.50 / $19,635.55
| Facility | | $7,869.25 | $12,446.50 | $19,635.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,114.25 / $10,246.16 / $19,803.16
| Facility | | $5,114.25 | $10,246.16 | $19,803.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $13,181.56 / $17,901.61
| Facility | | $6,289.00 | $13,181.56 | $17,901.61 |