- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,630.78 / $8,128.31
| Facility | | $1,348.96 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,905.46 / $1,905.46
| Facility | | $1,819.70 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $3,890.45
| Facility | | $660.69 | $977.24 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,398.83 / $3,630.78
| Facility | | $1,023.29 | $2,398.83 | $3,630.78 |