- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $38,904.51 / $83,176.38
| Facility | | $15,488.17 | $38,904.51 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $20,417.38
| Facility | | $6,025.60 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,317.64 / $16,218.10
| Facility | | $6,606.93 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $6,456.54
| Facility | | $2,344.23 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,311.31 / $8,511.38
| Facility | | $1,445.44 | $3,311.31 | $8,511.38 |