- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,517.37 / $9,966.82 / $9,966.82
| Facility | | $3,517.37 | $9,966.82 | $9,966.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.80 / $863.18 / $940.45
| Facility | | $777.80 | $863.18 | $940.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.19 / $1,247.19 / $1,247.19
| Facility | | $1,247.19 | $1,247.19 | $1,247.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,978.27 / $7,978.27 / $7,978.27
| Facility | | $7,978.27 | $7,978.27 | $7,978.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,357.60 / $16,357.60 / $16,357.60
| Facility | | $16,357.60 | $16,357.60 | $16,357.60 |