- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,317.25 / $11,032.60 / $14,799.30
| Facility | | $5,317.25 | $11,032.60 | $14,799.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,231.20 / $5,726.70 / $9,721.17
| Facility | | $5,231.20 | $5,726.70 | $9,721.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $12,007.64 / $14,277.64
| Facility | | $3,897.00 | $12,007.64 | $14,277.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,377.74 / $11,392.40 / $17,931.29
| Facility | | $9,377.74 | $11,392.40 | $17,931.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $14,075.01 / $17,775.74
| Facility | | $1,350.00 | $14,075.01 | $17,775.74 |