- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,570.88 / $9,120.11
| Facility | | $1,023.29 | $4,570.88 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,162.28 / $3,467.37
| Facility | | $1,548.82 | $3,162.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $10,964.78 / $10,964.78
| Facility | | $630.96 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $912.01 / $6,456.54
| Facility | | $489.78 | $912.01 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $11,748.98
| Facility | | $2,818.38 | $5,754.40 | $11,748.98 |