- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,943.28 / $20,892.96
| Facility | | $3,388.44 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $870.96
| Facility | | $758.58 | $758.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,495.41 / $12,022.64
| Facility | | $2,884.03 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,248.07 / $5,495.41
| Facility | | $4,265.80 | $5,248.07 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,715.35
| Facility | | $3,630.78 | $3,630.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $18,620.87 / $35,481.34
| Facility | | $14,125.38 | $18,620.87 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $21,379.62 / $41,686.94
| Facility | | $3,467.37 | $21,379.62 | $41,686.94 |