- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $14,791.08 / $52,480.75
| Facility | | $7,244.36 | $14,791.08 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,022.64 / $28,183.83
| Facility | | $8,317.64 | $12,022.64 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $22,387.21
| Facility | | $9,120.11 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,786.30 / $8,912.51
| Facility | | $3,019.95 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |