- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.70 / $3,802.72 / $8,042.30
| Facility | | $1,169.70 | $3,802.72 | $8,042.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.34 / $8,348.90 / $13,193.86
| Facility | | $5,227.34 | $8,348.90 | $13,193.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.44 / $1,189.55 / $6,840.79
| Facility | | $875.44 | $1,189.55 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |