- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,630.27 / $6,760.83
| Facility | | $1,047.13 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $15,488.17
| Facility | | $6,025.60 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $5,495.41
| Facility | | $891.25 | $1,380.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $5,754.40
| Facility | | $891.25 | $3,235.94 | $5,754.40 |