- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.20 / $1,577.61 / $4,529.52
| Facility | | $794.20 | $1,577.61 | $4,529.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.10 / $877.79 / $2,431.07
| Facility | | $806.10 | $877.79 | $2,431.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.20 / $3,019.20 / $3,019.20
| Facility | | $3,019.20 | $3,019.20 | $3,019.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $3,635.00 / $8,676.00
| Facility | | $2,000.00 | $3,635.00 | $8,676.00 |