- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,803.84 / $29,512.09
| Facility | | $7,244.36 | $13,803.84 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,897.79 / $11,481.54
| Facility | | $3,019.95 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,677.35 / $9,120.11
| Facility | | $3,715.35 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,041.74 / $3,981.07
| Facility | | $1,318.26 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,715.35 / $8,912.51
| Facility | | $1,445.44 | $3,715.35 | $8,912.51 |