- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $6,760.83
| Facility | | $1,737.80 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,096.48 / $1,995.26
| Facility | | $416.87 | $1,096.48 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,023.29
| Facility | | $741.31 | $977.24 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $2,454.71
| Facility | | $181.97 | $251.19 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $4,677.35
| Facility | | $977.24 | $1,698.24 | $4,677.35 |