- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,630.27 / $7,413.10
| Facility | | $812.83 | $2,630.27 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $741.31 / $1,778.28
| Facility | | $138.04 | $741.31 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $3,019.95
| Facility | | $1,071.52 | $1,445.44 | $3,019.95 |