- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,511.60 / $19,095.80 / $25,625.00
| Facility | | $11,511.60 | $19,095.80 | $25,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,988.52 / $10,988.52 / $14,283.75
| Facility | | $10,988.52 | $10,988.52 | $14,283.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,247.25 / $16,135.50 / $25,817.43
| Facility | | $9,247.25 | $16,135.50 | $25,817.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,452.54 / $15,375.00 / $35,261.03
| Facility | | $9,452.54 | $15,375.00 | $35,261.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,222.73 / $15,145.40 / $21,455.30
| Facility | | $11,222.73 | $15,145.40 | $21,455.30 |