- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $20,892.96
| Facility | | $2,137.96 | $2,951.21 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $954.99
| Facility | | $501.19 | $707.95 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $2,884.03
| Facility | | $1,096.48 | $2,041.74 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,187.76 / $2,290.87
| Facility | | $1,659.59 | $2,187.76 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,584.89
| Facility | | $1,548.82 | $1,548.82 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,258.93 / $5,754.40
| Facility | | $707.95 | $1,258.93 | $5,754.40 |