- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,456.54 / $16,982.44
| Facility | | $3,090.30 | $6,456.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $22,908.68 / $22,908.68
| Facility | | $21,877.62 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $16,982.44 / $16,982.44
| Facility | | $630.96 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,818.38 / $14,454.40
| Facility | | $1,548.82 | $2,818.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,715.19 / $21,379.62
| Facility | | $3,467.37 | $10,715.19 | $21,379.62 |