- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,715.35 / $6,760.83
| Facility | | $1,737.80 | $3,715.35 | $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
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,023.29 / $6,918.31
| Facility | | $645.65 | $1,023.29 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,073.80 / $7,244.36
| Facility | | $2,951.21 | $4,073.80 | $7,244.36 |