- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,786.30 / $8,317.64
| Facility | | $1,737.80 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $3,981.07
| Facility | | $794.33 | $794.33 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $5,623.41
| Facility | | $794.33 | $1,122.02 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,548.13 / $5,623.41
| Facility | | $1,445.44 | $3,548.13 | $5,623.41 |