- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.31 / $1,068.31 / $1,068.31
| Facility | | $1,068.31 | $1,068.31 | $1,068.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,246.62 / $11,345.35 / $24,108.80
| Facility | | $5,246.62 | $11,345.35 | $24,108.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,684.30 / $3,806.66 / $9,157.45
| Facility | | $2,684.30 | $3,806.66 | $9,157.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,182.14 / $3,480.20 / $7,210.59
| Facility | | $2,182.14 | $3,480.20 | $7,210.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.31 / $2,097.00 / $3,455.00
| Facility | | $1,498.31 | $2,097.00 | $3,455.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |