- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,370.32 / $5,495.41
| Facility | | $5,011.87 | $5,370.32 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $16.98 / $32.36
| Facility | | $12.02 | $16.98 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,467.37 / $11,748.98
| Facility | | $1,202.26 | $3,467.37 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $14,125.38 / $14,125.38
| Facility | | $5,011.87 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $8,511.38
| Facility | | $2,511.89 | $7,244.36 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $11,748.98
| Facility | | $891.25 | $2,630.27 | $11,748.98 |