- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.10 / $489.10 / $16,014.42
| Facility | | $489.10 | $489.10 | $16,014.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.32 / $11,716.49 / $25,424.06
| Facility | | $2,223.32 | $11,716.49 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.92 / $1,699.68 / $4,088.81
| Facility | | $1,197.92 | $1,699.68 | $4,088.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.02 / $1,553.92 / $3,219.54
| Facility | | $1,089.02 | $1,553.92 | $3,219.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.08 / $929.54 / $5,499.00
| Facility | | $523.08 | $929.54 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |