- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.82 / $1,720.82 / $1,720.82
| Facility | | $1,720.82 | $1,720.82 | $1,720.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,045.24 / $14,293.36 / $28,063.36
| Facility | | $8,045.24 | $14,293.36 | $28,063.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,252.08 / $6,033.09 / $14,513.42
| Facility | | $4,252.08 | $6,033.09 | $14,513.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,865.53 / $5,515.69 / $11,427.89
| Facility | | $3,865.53 | $5,515.69 | $11,427.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.40 / $3,058.57 / $5,987.70
| Facility | | $1,875.40 | $3,058.57 | $5,987.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |