- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.94 / $1,040.94 / $1,040.94
| Facility | | $1,040.94 | $1,040.94 | $1,040.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,807.03 / $9,426.86 / $18,388.81
| Facility | | $4,807.03 | $9,426.86 | $18,388.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.68 / $3,924.91 / $9,441.91
| Facility | | $2,767.68 | $3,924.91 | $9,441.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.92 / $3,588.31 / $7,434.58
| Facility | | $2,249.92 | $3,588.31 | $7,434.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.81 / $2,181.92 / $5,499.00
| Facility | | $1,406.81 | $2,181.92 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |