- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,011.87 / $8,317.64
| Facility | | $2,187.76 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,884.03 / $4,265.80
| Facility | | $891.25 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,290.87 / $8,128.31
| Facility | | $1,412.54 | $2,290.87 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,888.44 / $8,709.64
| Facility | | $4,168.69 | $5,888.44 | $8,709.64 |