- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.69 / $1,648.69 / $1,648.69
| Facility | | $1,648.69 | $1,648.69 | $1,648.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,642.72 / $9,708.70 / $16,191.22
| Facility | | $4,642.72 | $9,708.70 | $16,191.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,841.04 / $5,994.87 / $14,421.47
| Facility | | $3,841.04 | $5,994.87 | $14,421.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,328.60 / $5,470.71 / $11,355.49
| Facility | | $3,328.60 | $5,470.71 | $11,355.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.13 / $3,029.84 / $5,577.00
| Facility | | $1,790.13 | $3,029.84 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |