- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,162.28 / $5,754.40
| Facility | | $1,513.56 | $3,162.28 | $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
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $295.12 / $3,090.30
| Facility | | $177.83 | $295.12 | $3,090.30 |
- 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 |