- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $3,090.30
| Facility | | $1,621.81 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $18,620.87 / $18,620.87
| Facility | | $15.14 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $3,890.45 / $3,890.45
| Facility | | $95.50 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |