- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,854.30 / $12,524.40 / $17,557.50
| Facility | | $7,854.30 | $12,524.40 | $17,557.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.83 / $12,078.64 / $16,160.75
| Facility | | $9,496.83 | $12,078.64 | $16,160.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,468.75 / $11,967.62 / $18,131.20
| Facility | | $7,468.75 | $11,967.62 | $18,131.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $10,615.49 / $18,173.14
| Facility | | $6,564.00 | $10,615.49 | $18,173.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,564.00 / $11,445.73 / $17,198.08
| Facility | | $6,564.00 | $11,445.73 | $17,198.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,169.60 / $13,880.35 / $19,515.65
| Facility | | $7,169.60 | $13,880.35 | $19,515.65 |