- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,890.45 / $7,943.28
| Facility | | $1,584.89 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $707.95 / $741.31
| Facility | | $416.87 | $707.95 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,737.80 / $1,905.46
| Facility | | $331.13 | $1,737.80 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $588.84
| Facility | | $213.80 | $302.00 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $6,456.54 / $12,882.50
| Facility | | $1,230.27 | $6,456.54 | $12,882.50 |