- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,090.30 / $5,623.41
| Facility | | $1,258.93 | $3,090.30 | $5,623.41 |
- 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
- $331.13 / $1,445.44 / $1,659.59
| Facility | | $331.13 | $1,445.44 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $2,398.83
| Facility | | $363.08 | $575.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,951.21 / $5,370.32
| Facility | | $851.14 | $2,951.21 | $5,370.32 |