- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $8,228.00 / $18,772.50
| Facility | | $2,421.00 | $8,228.00 | $18,772.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,222.71 / $8,830.91 / $14,700.38
| Facility | | $3,222.71 | $8,830.91 | $14,700.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,682.67 / $16,355.54 / $29,173.66
| Facility | | $11,682.67 | $16,355.54 | $29,173.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,549.00 / $9,424.00 / $21,852.74
| Facility | | $6,549.00 | $9,424.00 | $21,852.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,427.00 / $8,752.00 / $20,372.15
| Facility | | $5,427.00 | $8,752.00 | $20,372.15 |