- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.16 / $1,676.16 / $1,676.16
| Facility | | $1,676.16 | $1,676.16 | $1,676.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,595.29 / $32,422.94 / $66,228.75
| Facility | | $8,595.29 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,128.33 / $5,857.51 / $14,091.03
| Facility | | $4,128.33 | $5,857.51 | $14,091.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,753.03 / $5,355.17 / $11,095.30
| Facility | | $3,753.03 | $5,355.17 | $11,095.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,832.71 / $4,642.64
| Facility | | $1,751.00 | $2,832.71 | $4,642.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |