- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $6,760.83
| Facility | | $1,737.80 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $436.52 / $3,162.28
| Facility | | $186.21 | $436.52 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,041.74 / $4,786.30
| Facility | | $1,288.25 | $2,041.74 | $4,786.30 |