- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,345.60 / $16,590.00 / $25,225.20
| Facility | | $9,345.60 | $16,590.00 | $25,225.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,183.33 / $11,339.00 / $15,625.56
| Facility | | $9,183.33 | $11,339.00 | $15,625.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,538.40 / $11,923.20 / $18,810.00
| Facility | | $7,538.40 | $11,923.20 | $18,810.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,999.76 / $10,662.31 / $19,921.68
| Facility | | $5,999.76 | $10,662.31 | $19,921.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,553.00 / $11,605.00 / $17,148.96
| Facility | | $6,553.00 | $11,605.00 | $17,148.96 |