- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $1,412.54
| Facility | | $1,122.02 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $16,218.10 / $32,359.37
| Facility | | $6,760.83 | $16,218.10 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,011.87 / $12,022.64
| Facility | | $3,548.13 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,786.30 / $9,332.54
| Facility | | $3,890.45 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $3,890.45
| Facility | | $1,230.27 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $9,332.54
| Facility | | $2,398.83 | $4,786.30 | $9,332.54 |