- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,786.30 / $8,511.38
| Facility | | $1,288.25 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,025.60 / $9,772.37
| Facility | | $3,801.89 | $6,025.60 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $933.25 / $7,413.10
| Facility | | $478.63 | $933.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |