- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,090.30 / $6,760.83
| Facility | | $1,698.24 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,445.44 / $2,691.53
| Facility | | $549.54 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,951.21 / $5,370.32
| Facility | | $446.68 | $2,951.21 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $3,801.89
| Facility | | $741.31 | $954.99 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,388.44 / $5,370.32
| Facility | | $1,949.84 | $3,388.44 | $5,370.32 |