- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.23 / $5,515.65 / $12,680.30
| Facility | | $1,231.23 | $5,515.65 | $12,680.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.99 / $1,159.13 / $1,952.01
| Facility | | $611.99 | $1,159.13 | $1,952.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.46 / $2,490.46 / $3,200.28
| Facility | | $2,490.46 | $2,490.46 | $3,200.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.28 / $773.61 / $1,165.35
| Facility | | $531.28 | $773.61 | $1,165.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |