- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,162.28 / $7,413.10
| Facility | | $1,513.56 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,412.54 / $3,235.94
| Facility | | $724.44 | $1,412.54 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $2,290.87
| Facility | | $177.83 | $288.40 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $3,019.95
| Facility | | $1,071.52 | $1,445.44 | $3,019.95 |