- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,570.88 / $7,413.10
| Facility | | $1,778.28 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $1,288.25
| Facility | | $794.33 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,248.07 / $8,912.51
| Facility | | $912.01 | $5,248.07 | $8,912.51 |