- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,803.27 / $6,420.55 / $11,298.30
| Facility | | $3,803.27 | $6,420.55 | $11,298.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,353.69 / $9,302.07 / $15,380.45
| Facility | | $6,353.69 | $9,302.07 | $15,380.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,459.67 / $5,918.18 / $8,519.46
| Facility | | $3,459.67 | $5,918.18 | $8,519.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,705.05 / $11,705.05 / $13,736.87
| Facility | | $11,705.05 | $11,705.05 | $13,736.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $5,595.45 / $7,992.47
| Facility | | $1,787.00 | $5,595.45 | $7,992.47 |