- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,511.89 / $5,754.40
| Facility | | $812.83 | $2,511.89 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,548.82 / $3,235.94
| Facility | | $758.58 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,754.23 / $4,677.35
| Facility | | $1,698.24 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $263.03 / $1,380.38
| Facility | | $104.71 | $263.03 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,951.21
| Facility | | $1,071.52 | $1,445.44 | $2,951.21 |