- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.43 / $4,357.50 / $15,726.20
| Facility | | $1,282.43 | $4,357.50 | $15,726.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,112.75 / $4,464.22 / $7,881.56
| Facility | | $2,112.75 | $4,464.22 | $7,881.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.29 / $2,130.29 / $2,737.46
| Facility | | $2,130.29 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.14 / $669.28 / $1,050.07
| Facility | | $494.14 | $669.28 | $1,050.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |