- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $11,220.18 / $17,378.01
| Facility | | $3,467.37 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,332.54 / $17,378.01
| Facility | | $3,715.35 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,715.35 / $4,786.30
| Facility | | $1,122.02 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $2,818.38
| Facility | | $1,148.15 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,378.01 / $26,302.68
| Facility | | $6,309.57 | $17,378.01 | $26,302.68 |