- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,715.35 / $7,413.10
| Facility | | $1,737.80 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,019.95
| Facility | | $630.96 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $6,918.31
| Facility | | $354.81 | $562.34 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,073.80 / $7,244.36
| Facility | | $3,019.95 | $4,073.80 | $7,244.36 |