- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.77 / $5,909.48 / $13,841.56
| Facility | | $518.77 | $5,909.48 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.23 / $1,181.41 / $2,285.23
| Facility | | $898.23 | $1,181.41 | $2,285.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.42 / $1,062.42 / $1,062.42
| Facility | | $1,062.42 | $1,062.42 | $1,062.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.72 / $648.46 / $1,609.64
| Facility | | $371.72 | $648.46 | $1,609.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.36 / $1,120.57 / $1,662.76
| Facility | | $758.36 | $1,120.57 | $1,662.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |