- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,715.35 / $7,943.28
| Facility | | $1,412.54 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,737.80
| Facility | | $588.84 | $588.84 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,090.30 / $26,302.68
| Facility | | $870.96 | $3,090.30 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $5,370.32
| Facility | | $2,137.96 | $3,019.95 | $5,370.32 |