- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $7,762.47
| Facility | | $1,348.96 | $1,348.96 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $13,803.84 / $31,622.78
| Facility | | $7,762.47 | $13,803.84 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,128.61 / $12,302.69
| Facility | | $3,235.94 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,897.79 / $9,772.37
| Facility | | $3,981.07 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $4,265.80
| Facility | | $1,258.93 | $2,089.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,943.28 / $12,589.25
| Facility | | $2,951.21 | $7,943.28 | $12,589.25 |