- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,162.28 / $5,754.40
| Facility | | $1,071.52 | $3,162.28 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,548.82 / $3,388.44
| Facility | | $724.44 | $1,548.82 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,630.27 / $4,677.35
| Facility | | $2,187.76 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $3,019.95
| Facility | | $147.91 | $251.19 | $3,019.95 |
- 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 |