- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,747.75 / $8,569.24 / $13,797.60
| Facility | | $3,747.75 | $8,569.24 | $13,797.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $5,930.56 / $11,429.69
| Facility | | $1,474.01 | $5,930.56 | $11,429.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,203.03 / $8,755.00 / $12,692.48
| Facility | | $6,203.03 | $8,755.00 | $12,692.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,422.13 / $7,514.74 / $15,781.88
| Facility | | $5,422.13 | $7,514.74 | $15,781.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.05 / $7,514.74 / $13,548.19
| Facility | | $5,005.05 | $7,514.74 | $13,548.19 |