- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,970.56 / $14,699.10
| Facility | | $2,318.00 | $6,970.56 | $14,699.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,844.05 / $9,504.85 / $15,286.55
| Facility | | $5,844.05 | $9,504.85 | $15,286.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,316.86 / $10,011.27 / $17,811.63
| Facility | | $6,316.86 | $10,011.27 | $17,811.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.00 / $7,857.79 / $21,062.29
| Facility | | $1,730.00 | $7,857.79 | $21,062.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $6,256.00 / $15,246.60
| Facility | | $1,500.00 | $6,256.00 | $15,246.60 |